Provider Demographics
NPI:1275651820
Name:MEDIA EYE WORKS LTD
Entity Type:Organization
Organization Name:MEDIA EYE WORKS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:DICKSON
Authorized Official - Last Name:MIELCAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-566-1522
Mailing Address - Street 1:319 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2615
Mailing Address - Country:US
Mailing Address - Phone:610-566-1522
Mailing Address - Fax:610-566-6888
Practice Address - Street 1:319 W STATE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2615
Practice Address - Country:US
Practice Address - Phone:610-566-1522
Practice Address - Fax:610-566-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6008670001Medicare NSC