Provider Demographics
NPI:1932479318
Name:ROGER ROMANCHIK
Entity Type:Organization
Organization Name:ROGER ROMANCHIK
Other - Org Name:MAIN STREET EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:OPT
Authorized Official - Phone:610-838-7220
Mailing Address - Street 1:1225 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1320
Mailing Address - Country:US
Mailing Address - Phone:610-838-7220
Mailing Address - Fax:
Practice Address - Street 1:1225 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1320
Practice Address - Country:US
Practice Address - Phone:610-838-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83307368305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service