Provider Demographics
NPI:1598705865
Name:INDIAN VALLEY EYE CARE INC.
Entity Type:Organization
Organization Name:INDIAN VALLEY EYE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRYNIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-256-9909
Mailing Address - Street 1:272 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438
Mailing Address - Country:US
Mailing Address - Phone:215-256-9909
Mailing Address - Fax:215-256-1296
Practice Address - Street 1:272 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438
Practice Address - Country:US
Practice Address - Phone:215-256-9909
Practice Address - Fax:215-256-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0908970001Medicare NSC
U10696Medicare UPIN
PAIN410753Medicare ID - Type Unspecified