Provider Demographics
NPI:1689733636
Name:EYE TO EYE CONTACT ASSOC PC
Entity Type:Organization
Organization Name:EYE TO EYE CONTACT ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-853-2001
Mailing Address - Street 1:1404 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2813
Mailing Address - Country:US
Mailing Address - Phone:610-853-2001
Mailing Address - Fax:610-853-3774
Practice Address - Street 1:1404 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2813
Practice Address - Country:US
Practice Address - Phone:610-853-2001
Practice Address - Fax:610-853-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005472T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABEO55643OtherBLUE SHIELD
PABEO55643OtherBLUE SHIELD
PA0784860001Medicare NSC