Provider Demographics
NPI:1326156779
Name:LAUREL EYE CLINIC
Entity Type:Organization
Organization Name:LAUREL EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-849-8344
Mailing Address - Street 1:363 BROAD ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1304
Mailing Address - Country:US
Mailing Address - Phone:814-275-2030
Mailing Address - Fax:
Practice Address - Street 1:363 BROAD ST
Practice Address - Street 2:STE 4
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1304
Practice Address - Country:US
Practice Address - Phone:814-275-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF3515OtherRAILROAD MEDICARE GROUP #
CF3515OtherRAILROAD MEDICARE GROUP #