Provider Demographics
NPI:1417124934
Name:MARCOE FAMILY EYECARE PC
Entity Type:Organization
Organization Name:MARCOE FAMILY EYECARE PC
Other - Org Name:KATHY MARCOE, O.D. P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-676-6979
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-0094
Mailing Address - Country:US
Mailing Address - Phone:814-676-6979
Mailing Address - Fax:814-676-6970
Practice Address - Street 1:10 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:CRANBERRY
Practice Address - State:PA
Practice Address - Zip Code:16319-3134
Practice Address - Country:US
Practice Address - Phone:814-676-6979
Practice Address - Fax:814-676-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001922253 0005Medicaid
PA102649777 0001Medicaid
PA001922253 0005Medicaid
PA102649777 0001Medicaid