Provider Demographics
NPI:1538476692
Name:EYE CARE FOR YOUNG EYES, L.L.C.
Entity Type:Organization
Organization Name:EYE CARE FOR YOUNG EYES, L.L.C.
Other - Org Name:GLASSES OUTLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:FLINT
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-737-2953
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19490-0074
Mailing Address - Country:US
Mailing Address - Phone:610-584-5626
Mailing Address - Fax:610-584-5627
Practice Address - Street 1:3401 SKIPPACK PIKE
Practice Address - Street 2:BUILDING D FIRST FLOOR
Practice Address - City:CEDARS
Practice Address - State:PA
Practice Address - Zip Code:19423
Practice Address - Country:US
Practice Address - Phone:610-584-5626
Practice Address - Fax:610-584-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000133152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81308Medicare UPIN