Provider Demographics
NPI:1073621728
Name:LOGIC EYECARE INC
Entity Type:Organization
Organization Name:LOGIC EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL- BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-548-2010
Mailing Address - Street 1:1137 E MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2901
Mailing Address - Country:US
Mailing Address - Phone:215-548-2010
Mailing Address - Fax:215-548-2130
Practice Address - Street 1:6101 LIMEKILN PIKE
Practice Address - Street 2:MEDICAL SUITE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-548-2010
Practice Address - Fax:215-548-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA223752000OtherKEYSTONE HEALTH PLAN EAST
PAP00010192OtherRAIL ROAD MEDICARE
PA097332OtherAETNA
PA20189OtherAMERICHOICE/SPECTERA VISI
PALH529261OtherBCBS
PA0019658780001Medicaid
PA0019658780001Medicaid