Provider Demographics
NPI:1417953928
Name:LEBANON EYECARE ASSOCIATES
Entity Type:Organization
Organization Name:LEBANON EYECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:717-272-3068
Mailing Address - Street 1:2627 WEST CUMBERLAND STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-272-3068
Mailing Address - Fax:717-272-1682
Practice Address - Street 1:2627 WEST CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-3068
Practice Address - Fax:717-272-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2519696386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1245490001OtherHEALTHNOW (DMERC)
PAPA6663OtherEYEMED
PA3000058OtherKEYSTONE HEALTH PLAN
PA396296OtherNATIONAL VISION ADMIN.
PA396296OtherCAPTIAL BLUE CROSS NVA
PA396296OtherPROVANTAGE
PA2075558OtherAETNA
PA32735OtherHEALTHGUARD
PA4482OtherGEISINGER
PA02448800OtherNCAS
PA02448800OtherCAPTIAL BLUE CROSS
PA1245490001OtherPALMETTO
PALE743579OtherFEDERAL EMPLOYEE PROGRAM
PALE743579OtherHIGHMARK BLUE SHIELD
PA396296OtherPROVANTAGE
PAPA6663OtherEYEMED
PA7434579Medicare ID - Type Unspecified