Provider Demographics
NPI:1629217054
Name:ROSE TREE CROSSROADS EYE CARE, P.C.
Entity Type:Organization
Organization Name:ROSE TREE CROSSROADS EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-566-6484
Mailing Address - Street 1:1315 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1205
Mailing Address - Country:US
Mailing Address - Phone:610-566-6484
Mailing Address - Fax:610-566-6464
Practice Address - Street 1:1315 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1205
Practice Address - Country:US
Practice Address - Phone:610-566-6484
Practice Address - Fax:610-566-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7776303Medicaid
PAGU433611Medicare PIN
PA6259530001Medicare NSC
PA30402Medicare UPIN