Provider Demographics
NPI:1063865053
Name:GP EYECARE SPECIALISTS
Entity Type:Organization
Organization Name:GP EYECARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-488-9030
Mailing Address - Street 1:3461 HORIZON BLVD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4967
Mailing Address - Country:US
Mailing Address - Phone:215-942-7671
Mailing Address - Fax:215-942-7673
Practice Address - Street 1:3461 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4967
Practice Address - Country:US
Practice Address - Phone:215-942-7671
Practice Address - Fax:215-942-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002493152W00000X
PAOEG002790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026245530001Medicaid