Provider Demographics
NPI:1184805954
Name:EVANS EYE CARE
Entity type:Organization
Organization Name:EVANS EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-735-6000
Mailing Address - Street 1:245 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2443
Mailing Address - Country:US
Mailing Address - Phone:570-735-6000
Mailing Address - Fax:570-735-5300
Practice Address - Street 1:245 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2443
Practice Address - Country:US
Practice Address - Phone:570-735-6000
Practice Address - Fax:570-735-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACM6883OtherRAILROAD MEDICARE
PA0321620001Medicare NSC
PACM6883OtherRAILROAD MEDICARE