Provider Demographics
NPI:1821078569
Name:RESTORE EYE CARE, P.C.
Entity Type:Organization
Organization Name:RESTORE EYE CARE, P.C.
Other - Org Name:SEPICH EYE CARE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEPICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-272-0262
Mailing Address - Street 1:100 OAKWOOD AVE
Mailing Address - Street 2:OAKWOOD CENTRE STE 300
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:814-272-0262
Mailing Address - Fax:814-272-1501
Practice Address - Street 1:100 OAKWOOD AVE
Practice Address - Street 2:OAKWOOD CENTRE STE 300
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-272-0262
Practice Address - Fax:814-272-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
096902Medicare ID - Type Unspecified
U29457Medicare UPIN