Provider Demographics
NPI:1588666200
Name:CHESTER COUNTY EYE CARE ASSOC PC
Entity Type:Organization
Organization Name:CHESTER COUNTY EYE CARE ASSOC PC
Other - Org Name:CHESTER COUNTY EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-696-1230
Mailing Address - Street 1:915 OLD FERN HILL RD BLDG B STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-696-1230
Mailing Address - Fax:610-918-0803
Practice Address - Street 1:915 OLD FERN HILL RD BLDG B STE 200
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-696-1230
Practice Address - Fax:610-696-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X, 207W00000X
152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016148270008Medicaid
PA0016148270008Medicaid
PA513605Medicare ID - Type Unspecified