Provider Demographics
NPI:1497051163
Name:THE EYEGLASS SHOPPE, INC.
Entity Type:Organization
Organization Name:THE EYEGLASS SHOPPE, INC.
Other - Org Name:SOMERSET FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BROWNFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-445-4495
Mailing Address - Street 1:121 S CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2031
Mailing Address - Country:US
Mailing Address - Phone:814-445-4495
Mailing Address - Fax:814-445-6432
Practice Address - Street 1:121 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2031
Practice Address - Country:US
Practice Address - Phone:814-445-4495
Practice Address - Fax:814-445-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139055Medicare PIN
PADR3550Medicare PIN
PA6684710001Medicare NSC