Provider Demographics
NPI:1114047206
Name:KARL E STREILEIN OPTOMETRY, PC
Entity Type:Organization
Organization Name:KARL E STREILEIN OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:STREILEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-665-2020
Mailing Address - Street 1:216 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1627
Mailing Address - Country:US
Mailing Address - Phone:814-665-2020
Mailing Address - Fax:814-664-4382
Practice Address - Street 1:216 N CENTER ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1627
Practice Address - Country:US
Practice Address - Phone:814-665-2020
Practice Address - Fax:814-664-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011539530006Medicaid
PAKA1347367OtherBLUE SHIELD
PA0011539530005Medicaid
PA42287OtherDAVIS VISION
PAPA6532OtherEYEMED
PAPA96532OtherVBA
PA0011539530006Medicaid
PA=========OtherVSP
PA056794Medicare ID - Type Unspecified
PA0011539530005Medicaid
PA4438550001Medicare NSC