Provider Demographics
NPI:1710168505
Name:ROBERT P. MCCANDLESS
Entity Type:Organization
Organization Name:ROBERT P. MCCANDLESS
Other - Org Name:PATRICK MCCANDLESS OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCANDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:215-766-8100
Mailing Address - Street 1:5891 EASTON ROAD
Mailing Address - Street 2:PO BOX 432
Mailing Address - City:PLUMSTEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18949-0432
Mailing Address - Country:US
Mailing Address - Phone:215-766-8100
Mailing Address - Fax:215-766-8103
Practice Address - Street 1:5891 EASTON ROAD
Practice Address - Street 2:
Practice Address - City:PLUMSTEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:18949-0432
Practice Address - Country:US
Practice Address - Phone:215-766-8100
Practice Address - Fax:215-766-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1163050001Medicare NSC