Provider Demographics
NPI:1992364897
Name:HERMITAGE EYE & LASER CENTER
Entity Type:Organization
Organization Name:HERMITAGE EYE & LASER CENTER
Other - Org Name:JOSEPH EYE & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-979-6767
Mailing Address - Street 1:2151 SHENANGO VALLEY FWY STE C-5
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2586
Mailing Address - Country:US
Mailing Address - Phone:724-877-7991
Mailing Address - Fax:330-619-3175
Practice Address - Street 1:2151 SHENANGO VALLEY FWY STE C-5
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2586
Practice Address - Country:US
Practice Address - Phone:724-877-7991
Practice Address - Fax:330-619-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025846180007Medicaid