Provider Demographics
NPI:1407976020
Name:SUBURBAN EYE CARE OPTOMETRIC
Entity Type:Organization
Organization Name:SUBURBAN EYE CARE OPTOMETRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-631-1142
Mailing Address - Street 1:10 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TROOPER
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1655
Mailing Address - Country:US
Mailing Address - Phone:610-631-1142
Mailing Address - Fax:
Practice Address - Street 1:10 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TROOPER
Practice Address - State:PA
Practice Address - Zip Code:19403-1655
Practice Address - Country:US
Practice Address - Phone:610-631-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
113996OtherAETNA
139725OtherOXFORD
2116909000OtherKEYSTONE
PASU507539OtherAMERICHOICE
NJ113996OtherBLUE SHIELD NJ
94012OtherAETNA HMO
94012OtherAETNA HMO
U37452Medicare UPIN