Provider Demographics
NPI:1558662460
Name:EYE CONSULTANTS OF PENNSYLVANIA, PC
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF PENNSYLVANIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:I
Authorized Official - Last Name:BUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:610-378-1348
Mailing Address - Street 1:1 GRANITE POINT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1992
Mailing Address - Country:US
Mailing Address - Phone:610-378-1344
Mailing Address - Fax:610-378-5169
Practice Address - Street 1:219 E WESNER RD
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9729
Practice Address - Country:US
Practice Address - Phone:610-926-4241
Practice Address - Fax:610-926-8160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CONSULTANTS OF PENNSYLVANIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006688410023Medicaid
PA0006688410018Medicaid
PA148561Medicare PIN
PA0310830001Medicare NSC