Provider Demographics
NPI:1033142963
Name:SPRINGFIELD EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:SPRINGFIELD EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GANLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-327-4911
Mailing Address - Street 1:ROUTES 724 & 100
Mailing Address - Street 2:LENSCRAFTERS IN COVENTRY MALL-SPACE H16
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465
Mailing Address - Country:US
Mailing Address - Phone:610-327-4911
Mailing Address - Fax:
Practice Address - Street 1:ROUTES 724 & 100
Practice Address - Street 2:LENSCRAFTERS IN COVENTRY MALL-SPACE H16
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465
Practice Address - Country:US
Practice Address - Phone:610-327-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN