Provider Demographics
NPI:1104188044
Name:KOURY FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:KOURY FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOURY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-633-5554
Mailing Address - Street 1:495 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5215
Mailing Address - Country:US
Mailing Address - Phone:717-633-5554
Mailing Address - Fax:717-633-5584
Practice Address - Street 1:495 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5215
Practice Address - Country:US
Practice Address - Phone:717-633-5554
Practice Address - Fax:717-633-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty