Provider Demographics
NPI:1245438894
Name:HARRISBURG EYE CARE, P.C.
Entity type:Organization
Organization Name:HARRISBURG EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-213-2020
Mailing Address - Street 1:220 S CLIFF AVE #102
Mailing Address - Street 2:PO BOX 298
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032
Mailing Address - Country:US
Mailing Address - Phone:605-213-2020
Mailing Address - Fax:
Practice Address - Street 1:220 S CLIFF AVE
Practice Address - Street 2:#102
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032
Practice Address - Country:US
Practice Address - Phone:605-213-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203752Medicaid
SD9203752Medicaid