Provider Demographics
NPI:1225159585
Name:KNEISLEY EYE CARE PA
Entity Type:Organization
Organization Name:KNEISLEY EYE CARE PA
Other - Org Name:SIMON EYE ASSOCIATES NEWARK PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:KNEISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS OD
Authorized Official - Phone:302-224-3000
Mailing Address - Street 1:45 EAST MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4600
Mailing Address - Country:US
Mailing Address - Phone:302-224-3000
Mailing Address - Fax:302-224-1524
Practice Address - Street 1:45 EAST MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4600
Practice Address - Country:US
Practice Address - Phone:302-224-3000
Practice Address - Fax:302-224-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE I30001215152W00000X, 156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherBUSINESS TAX ID
U59713Medicare UPIN
807535S05Medicare ID - Type Unspecified