Provider Demographics
NPI:1295146496
Name:EAGLE OPTOMETRIC PC
Entity type:Organization
Organization Name:EAGLE OPTOMETRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRONAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-310-9946
Mailing Address - Street 1:31 S EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3340
Mailing Address - Country:US
Mailing Address - Phone:610-310-9946
Mailing Address - Fax:
Practice Address - Street 1:578 SUSQUEHANNA BLVD
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-3233
Practice Address - Country:US
Practice Address - Phone:610-310-9946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty