Provider Demographics
NPI:1083621114
Name:LECKEMBY EYECARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LECKEMBY EYECARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LECKEMBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-933-2177
Mailing Address - Street 1:523 KIMBERTON RD
Mailing Address - Street 2:STE. 11C
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4745
Mailing Address - Country:US
Mailing Address - Phone:610-933-2177
Mailing Address - Fax:610-933-8782
Practice Address - Street 1:523 KIMBERTON RD
Practice Address - Street 2:STE. 11C
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4745
Practice Address - Country:US
Practice Address - Phone:610-933-2177
Practice Address - Fax:610-933-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U13193Medicare UPIN
1376815Medicare ID - Type UnspecifiedGROUP #