Provider Demographics
NPI:1619614609
Name:EYE CARE ON 3RD INC
Entity Type:Organization
Organization Name:EYE CARE ON 3RD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DEPT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAVRANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-974-5047
Mailing Address - Street 1:903 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-1916
Mailing Address - Country:US
Mailing Address - Phone:724-561-3630
Mailing Address - Fax:
Practice Address - Street 1:903 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1916
Practice Address - Country:US
Practice Address - Phone:724-561-3630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty