Provider Demographics
NPI:1659885374
Name:NANNY'S EYE CARE FOR KIDS, P.C.
Entity Type:Organization
Organization Name:NANNY'S EYE CARE FOR KIDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANNETTE ZALE
Authorized Official - Middle Name:
Authorized Official - Last Name:REFICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-507-9399
Mailing Address - Street 1:625 E. DRINKER ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2548
Mailing Address - Country:US
Mailing Address - Phone:570-507-9399
Mailing Address - Fax:507-871-4756
Practice Address - Street 1:625 E DRINKER ST STE 1
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2548
Practice Address - Country:US
Practice Address - Phone:570-507-9399
Practice Address - Fax:507-871-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065460L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017529210011Medicaid