Provider Demographics
NPI:1417916404
Name:RICHARD E SHEAFFER & PHILLIP L WISE
Entity Type:Organization
Organization Name:RICHARD E SHEAFFER & PHILLIP L WISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:SHEAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-374-8136
Mailing Address - Street 1:326 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1512
Mailing Address - Country:US
Mailing Address - Phone:570-374-8136
Mailing Address - Fax:570-374-0462
Practice Address - Street 1:326 BROAD ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1512
Practice Address - Country:US
Practice Address - Phone:570-374-8136
Practice Address - Fax:570-374-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12549200OtherCAPITAL BLUE CROSS
PA1592OtherGEISINGER HEALTH PLAN
PA0012999300005Medicaid
PA1592OtherGEISINGER HEALTH PLAN
PA158884Medicare PIN