Provider Demographics
NPI:1790887131
Name:LAUREL EYE CLINIC
Entity Type:Organization
Organization Name:LAUREL EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-849-8344
Mailing Address - Street 1:50 WATERFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2518
Mailing Address - Country:US
Mailing Address - Phone:814-849-8344
Mailing Address - Fax:814-849-7130
Practice Address - Street 1:50 WATERFORD PIKE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2518
Practice Address - Country:US
Practice Address - Phone:814-849-8344
Practice Address - Fax:814-849-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF3515OtherRAILROAD MEDICARE GROUP #
CF3515OtherRAILROAD MEDICARE GROUP #