Provider Demographics
NPI:1760564223
Name:ANGELINA THERESA BUCCI EYE SURGERY CENTER
Entity Type:Organization
Organization Name:ANGELINA THERESA BUCCI EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-825-5949
Mailing Address - Street 1:158 WILKES BARRE TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6704
Mailing Address - Country:US
Mailing Address - Phone:570-825-5949
Mailing Address - Fax:570-825-2645
Practice Address - Street 1:158 WILKES BARRE TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6704
Practice Address - Country:US
Practice Address - Phone:570-825-5949
Practice Address - Fax:570-825-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01868435Medicaid
PA049700Medicare ID - Type Unspecified
PA01868435Medicaid