Provider Demographics
NPI:1154460095
Name:THE EYECARE BOUTIQUE, CO.
Entity Type:Organization
Organization Name:THE EYECARE BOUTIQUE, CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATSCHERZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-940-0150
Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9381
Mailing Address - Country:US
Mailing Address - Phone:724-940-0150
Mailing Address - Fax:724-940-0244
Practice Address - Street 1:11279 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9381
Practice Address - Country:US
Practice Address - Phone:724-940-0150
Practice Address - Fax:724-940-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1497747620OtherINDIVIDUAL NPI
PAU36220Medicare UPIN
PA1310860001Medicare NSC
PA156518Medicare PIN