Provider Demographics
NPI:1407975410
Name:LAUREL EYE CLINIC
Entity Type:Organization
Organization Name:LAUREL EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICHAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-849-8344
Mailing Address - Street 1:176 VISION DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635
Mailing Address - Country:US
Mailing Address - Phone:814-949-8808
Mailing Address - Fax:
Practice Address - Street 1:176 VISION DRIVE
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-949-8808
Practice Address - Fax:814-949-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF3515OtherRAILROAD MEDICARE GROUP #
0736170009Medicare NSC