Provider Demographics
NPI:1235383498
Name:EYE STORE-SHOPPE LLC
Entity Type:Organization
Organization Name:EYE STORE-SHOPPE LLC
Other - Org Name:JEFFREY KEHR SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-489-4100
Mailing Address - Street 1:222 E MAIN ST STE 114
Mailing Address - Street 2:COLLEGEVILLE SHOPPING CENTER
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2650
Mailing Address - Country:US
Mailing Address - Phone:610-489-4100
Mailing Address - Fax:610-489-8458
Practice Address - Street 1:222 E MAIN ST STE 114
Practice Address - Street 2:COLLEGEVILLE SHOPPING CENTER
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2650
Practice Address - Country:US
Practice Address - Phone:610-489-4100
Practice Address - Fax:610-489-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0530710001Medicare NSC
454664Medicare PIN
PA6330500001Medicare NSC