Provider Demographics
NPI:1659524767
Name:EYE CARE CENTER
Entity Type:Organization
Organization Name:EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:570-421-2680
Mailing Address - Street 1:1036 N. 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1210
Mailing Address - Country:US
Mailing Address - Phone:570-421-2680
Mailing Address - Fax:570-421-2713
Practice Address - Street 1:1036 N. 9TH ST.
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1210
Practice Address - Country:US
Practice Address - Phone:570-421-2680
Practice Address - Fax:570-421-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0637950001Medicare NSC