Provider Demographics
NPI:1043420706
Name:CENTRAL PENN VISION ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL PENN VISION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOZARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-684-0331
Mailing Address - Street 1:1058 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1536
Mailing Address - Country:US
Mailing Address - Phone:814-684-0331
Mailing Address - Fax:814-684-0331
Practice Address - Street 1:1058 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1536
Practice Address - Country:US
Practice Address - Phone:814-684-0331
Practice Address - Fax:814-684-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085981Medicare ID - Type Unspecified
PAU51535Medicare UPIN
PA533684Medicare ID - Type Unspecified
PAV07822Medicare UPIN