Provider Demographics
NPI:1275713596
Name:STEPHEN J DRABICK OD PC
Entity Type:Organization
Organization Name:STEPHEN J DRABICK OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRABICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-769-4000
Mailing Address - Street 1:4110 INDEPENDENCE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2585
Mailing Address - Country:US
Mailing Address - Phone:610-769-4000
Mailing Address - Fax:
Practice Address - Street 1:4110 INDEPENDENCE DR STE 400
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2585
Practice Address - Country:US
Practice Address - Phone:610-769-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0602820001Medicare NSC
PA097759Medicare PIN