Provider Demographics
NPI:1235120072
Name:LAUREL EYE CLINIC
Entity Type:Organization
Organization Name:LAUREL EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICHAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-849-8344
Mailing Address - Street 1:50 WATERFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2518
Mailing Address - Country:US
Mailing Address - Phone:814-849-8344
Mailing Address - Fax:814-849-7130
Practice Address - Street 1:50 WATERFORD PIKE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2518
Practice Address - Country:US
Practice Address - Phone:814-849-8344
Practice Address - Fax:814-849-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007384840027Medicaid
614146Medicare ID - Type Unspecified