Provider Demographics
NPI:1437348539
Name:WYOMISSING OPTOMETRIC CENTER, INC.
Entity Type:Organization
Organization Name:WYOMISSING OPTOMETRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-374-3134
Mailing Address - Street 1:50 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1219
Mailing Address - Country:US
Mailing Address - Phone:610-374-3134
Mailing Address - Fax:610-374-0484
Practice Address - Street 1:1050 BENJAMIN FRANKLIN HIGHWAY WEST
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518
Practice Address - Country:US
Practice Address - Phone:610-385-4333
Practice Address - Fax:610-385-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366404345OtherGEISINGER HEALTH PLAN
PA1366404345OtherHUMANA
PA0020572000OtherINEPENDENCE BC/BS
PA1366404345OtherCIGNA HEALTHCARE
PA29436OtherSPECTERA
PA338133OtherHEALTH AMERICA/HEALTH ASS
PA1366404345OtherUNITED HEALTHCARE
PA5586009OtherAETNA TRADITIONAL/PPO
PA02525100OtherKEYSTONE SENIOR BLUE GROUP #
PA1366404345OtherBERKSHIRE HEALTH PARTNERS
PA1366404345OtherSECURE HORIZON
PACM6302OtherMEDICARE RAILROAD
PA0020592000OtherKEYSTONE EAST GROUP #
PA429305OtherHIGHMARK/BLUE SHIELD
PA54384OtherDAVIS AFFINITY
PA02525100OtherCAPITOL BLUE CROSS
PA0020592000OtherAMERIHEALTH GROUP #
PA0050038OtherAETNA/HMO
PA429305OtherHIGHMARK/BLUE SHIELD
PA429305Medicare PIN