Provider Demographics
NPI:1750474003
Name:KANE, EUGENE L (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:L
Last Name:KANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2906
Mailing Address - Country:US
Mailing Address - Phone:610-566-1693
Mailing Address - Fax:610-566-2229
Practice Address - Street 1:24 E SECOND ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2906
Practice Address - Country:US
Practice Address - Phone:610-566-1693
Practice Address - Fax:610-566-2229
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3503P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA407815Medicare UPIN
PA282656Medicare PIN