Provider Demographics
NPI:1003287558
Name:CORL EYECARE, LLC
Entity Type:Organization
Organization Name:CORL EYECARE, LLC
Other - Org Name:CORL FAMILY EYECARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-269-5346
Mailing Address - Street 1:2901 HORSESHOE PIKE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078
Mailing Address - Country:US
Mailing Address - Phone:717-473-3802
Mailing Address - Fax:717-641-3074
Practice Address - Street 1:2901 HORSESHOE PIKE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078
Practice Address - Country:US
Practice Address - Phone:717-473-3802
Practice Address - Fax:717-641-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty