Provider Demographics
| NPI: | 1033181904 |
|---|---|
| Name: | EYE CONSULTANTS OF PENNSYLVANIA, PC |
| Entity Type: | Organization |
| Organization Name: | EYE CONSULTANTS OF PENNSYLVANIA, PC |
| Other - Org Name: | WEST READING OPHTHALMIC ASSOCIATES |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | CHARLES |
| Authorized Official - Middle Name: | I |
| Authorized Official - Last Name: | BUSACK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MHA |
| Authorized Official - Phone: | 610-378-1348 |
| Mailing Address - Street 1: | 1 GRANITE POINT DR STE 100 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WYOMISSING |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 19610-1992 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 610-378-1344 |
| Mailing Address - Fax: | 610-378-5169 |
| Practice Address - Street 1: | 1 GRANITE POINT DR STE 100 |
| Practice Address - Street 2: | |
| Practice Address - City: | WYOMISSING |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 19610-1992 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 610-378-1344 |
| Practice Address - Fax: | 610-378-5169 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-02-06 |
| Last Update Date: | 2023-06-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 152WC0802X | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | Group - Multi-Specialty |
| No | 152WL0500X | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | Group - Multi-Specialty |
| No | 152WV0400X | Eye and Vision Services Providers | Optometrist | Vision Therapy | Group - Multi-Specialty |
| No | 207WX0009X | Allopathic & Osteopathic Physicians | Ophthalmology | Glaucoma Specialist | Group - Multi-Specialty |
| No | 207WX0107X | Allopathic & Osteopathic Physicians | Ophthalmology | Retina Specialist | Group - Multi-Specialty |
| No | 207WX0109X | Allopathic & Osteopathic Physicians | Ophthalmology | Neuro-ophthalmology | Group - Multi-Specialty |
| No | 207WX0110X | Allopathic & Osteopathic Physicians | Ophthalmology | Pediatric Ophthalmology and Strabismus Specialist | Group - Multi-Specialty |
| No | 207WX0120X | Allopathic & Osteopathic Physicians | Ophthalmology | Cornea and External Diseases Specialist | Group - Multi-Specialty |
| No | 207WX0200X | Allopathic & Osteopathic Physicians | Ophthalmology | Ophthalmic Plastic and Reconstructive Surgery | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 0006688410005 | Medicaid | |
| PA | 0006688410024 | Medicaid | |
| PA | 0006688410018 | Medicaid | |
| PA | 0006688410021 | Medicaid | |
| PA | 0006688410022 | Medicaid | |
| PA | 0006688410020 | Medicaid | |
| PA | 0006688410017 | Medicaid | |
| PA | 0006688410019 | Medicaid | |
| PA | 0006688410025 | Medicaid | |
| PA | 0006688410023 | Medicaid |
