Provider Demographics
NPI:1144380601
Name:FAMILY EYE HEALTH CENTER P C
Entity Type:Organization
Organization Name:FAMILY EYE HEALTH CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-368-7090
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2004
Mailing Address - Country:US
Mailing Address - Phone:814-368-7090
Mailing Address - Fax:814-368-5855
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2004
Practice Address - Country:US
Practice Address - Phone:814-368-7090
Practice Address - Fax:814-368-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3687090OtherVSP
15156OtherSPECTERA
PA073044001OtherTRAVELERS MEDICARE
212025OtherUPMC
3740OtherECPA
000131398OtherBLUE CARD
PA410018195OtherRR MEDICARE
000131398OtherHIGHMARK BLUE CROSS
000131398OtherKEYSTONE BLUE WEST
0005752970001OtherDPA
390850OtherNVA
7043OtherVBA
000131398OtherPREFERRED BLUE PPO WEST
PA0005752970001Medicaid
53929OtherDAVIS VISION
PA410018195OtherRR MEDICARE
PAFA131398Medicare ID - Type Unspecified