Provider Demographics
NPI:1376877704
Name:SISSON - BOYER EYECARE, LLC
Entity Type:Organization
Organization Name:SISSON - BOYER EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-567-3103
Mailing Address - Street 1:7 CRAMER DR
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8720
Mailing Address - Country:US
Mailing Address - Phone:717-567-3103
Mailing Address - Fax:
Practice Address - Street 1:7 CRAMER DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8720
Practice Address - Country:US
Practice Address - Phone:717-567-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000258152W00000X
PAOEG000253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty