Provider Demographics
NPI:1275600454
Name:EYE CARE PROFESSIONAL ASSOCIATES
Entity Type:Organization
Organization Name:EYE CARE PROFESSIONAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASAMENTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-726-1104
Mailing Address - Street 1:1650 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4890
Mailing Address - Country:US
Mailing Address - Phone:814-726-1104
Mailing Address - Fax:814-726-9090
Practice Address - Street 1:1650 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4890
Practice Address - Country:US
Practice Address - Phone:814-726-1104
Practice Address - Fax:814-726-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0575297Medicaid
PA064193Medicare ID - Type Unspecified