Provider Demographics
NPI:1013958313
Name:EAST PENN EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EAST PENN EYE ASSOCIATES, INC.
Other - Org Name:WESTGATE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPERING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-867-1182
Mailing Address - Street 1:2045 WESTGATE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7480
Mailing Address - Country:US
Mailing Address - Phone:610-867-1182
Mailing Address - Fax:610-866-2196
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7480
Practice Address - Country:US
Practice Address - Phone:610-867-1182
Practice Address - Fax:610-866-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000088152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU50752Medicare UPIN
PA4708100001Medicare NSC