Provider Demographics
NPI:1982662680
Name:MECHANICSBURG EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:MECHANICSBURG EYE ASSOCIATES LLC
Other - Org Name:MECHANICSBURG EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:VOSS
Authorized Official - Last Name:MELOY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-766-4757
Mailing Address - Street 1:100 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-3364
Mailing Address - Country:US
Mailing Address - Phone:717-766-4757
Mailing Address - Fax:717-766-7563
Practice Address - Street 1:100 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-3364
Practice Address - Country:US
Practice Address - Phone:717-766-4757
Practice Address - Fax:717-766-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6126650001Medicare NSC
PA555523Medicare PIN