Provider Demographics
NPI:1568644466
Name:ADVANCED EYECARE SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCED EYECARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-322-6892
Mailing Address - Street 1:2055 ROUTE 611
Mailing Address - Street 2:
Mailing Address - City:SWIFTWATER
Mailing Address - State:PA
Mailing Address - Zip Code:18370
Mailing Address - Country:US
Mailing Address - Phone:570-839-2221
Mailing Address - Fax:570-839-2576
Practice Address - Street 1:2055 ROUTE 611
Practice Address - Street 2:
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370
Practice Address - Country:US
Practice Address - Phone:570-839-2221
Practice Address - Fax:570-839-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1652796OtherBCBS
PA5234646OtherAETNA
PA5234646OtherAETNA
PA088320Medicare PIN
PA1127870001Medicare NSC