Provider Demographics
NPI:1558759027
Name:GEISINGER CLINIC
Entity Type:Organization
Organization Name:GEISINGER CLINIC
Other - Org Name:GEISINGER OPHTHALMOLOGY LEWISBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR SYSTEM CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-6144
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:115 FARLEY CIR
Practice Address - Street 2:STE 107
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9252
Practice Address - Country:US
Practice Address - Phone:570-522-0700
Practice Address - Fax:570-522-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty