Provider Demographics
NPI:1922252758
Name:YOUR FAMILY EYE DOCTORS, INC.
Entity Type:Organization
Organization Name:YOUR FAMILY EYE DOCTORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAKANAC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-864-7777
Mailing Address - Street 1:8775 NORWIN AVE
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2718
Mailing Address - Country:US
Mailing Address - Phone:724-864-7777
Mailing Address - Fax:724-864-7779
Practice Address - Street 1:20475 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-7529
Practice Address - Country:US
Practice Address - Phone:724-776-1079
Practice Address - Fax:724-742-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA704404OtherHIGHMARK BLUE CROSS/BLUE SHIELD
0534900004Medicare NSC
PA704404Medicare PIN