Provider Demographics
NPI:1972604346
Name:THE EYE CENTER OF CENTRAL PA
Entity Type:Organization
Organization Name:THE EYE CENTER OF CENTRAL PA
Other - Org Name:THE EYE CENTER OF CENTRAL PA/OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CCO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-966-5582
Mailing Address - Street 1:88 HARDEES DR
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7062
Mailing Address - Country:US
Mailing Address - Phone:570-966-5582
Mailing Address - Fax:
Practice Address - Street 1:137 JPM RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9313
Practice Address - Country:US
Practice Address - Phone:570-523-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001684775OtherHIGHMARK