Provider Demographics
NPI:1073551743
Name:MYERSTOWN FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:MYERSTOWN FAMILY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-866-1400
Mailing Address - Street 1:356 W MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1023
Mailing Address - Country:US
Mailing Address - Phone:717-866-1400
Mailing Address - Fax:717-866-9954
Practice Address - Street 1:356 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1023
Practice Address - Country:US
Practice Address - Phone:717-866-1400
Practice Address - Fax:717-866-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000422152W00000X
OEG 000422152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3883130001Medicare NSC
PA451544ZDHKMedicare UPIN
PA150565Medicare PIN