Provider Demographics
NPI:1902822331
Name:WICHRYK EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WICHRYK EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONI
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WICHRYK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-965-1800
Mailing Address - Street 1:6451 VILLAGE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8484
Mailing Address - Country:US
Mailing Address - Phone:610-965-1800
Mailing Address - Fax:
Practice Address - Street 1:6451 VILLAGE LN
Practice Address - Street 2:SUITE 200
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8484
Practice Address - Country:US
Practice Address - Phone:610-965-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017439OtherAETNA US HEALTHCARE
PA267858OtherBLUE SHIELD
PA267858OtherBLUE SHIELD
PA6856320001Medicare NSC
PA008149Medicare ID - Type Unspecified