Provider Demographics
NPI:1730130246
Name:PENNSYLVANIA EYE SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:PENNSYLVANIA EYE SURGERY CENTER, INC.
Other - Org Name:MEMORIAL EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOTINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-657-2020
Mailing Address - Street 1:4100 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1071
Mailing Address - Country:US
Mailing Address - Phone:717-657-2020
Mailing Address - Fax:717-657-2071
Practice Address - Street 1:4100 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1071
Practice Address - Country:US
Practice Address - Phone:717-657-2020
Practice Address - Fax:717-657-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16421500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA303273Medicare ID - Type Unspecified