Provider Demographics
NPI:1336154087
Name:TRI-CENTURY EYE CARE, PC
Entity Type:Organization
Organization Name:TRI-CENTURY EYE CARE, PC
Other - Org Name:CENTURY EYE CARE, LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANNARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-781-2020
Mailing Address - Street 1:216 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007
Mailing Address - Country:US
Mailing Address - Phone:215-781-2020
Mailing Address - Fax:215-781-6794
Practice Address - Street 1:319 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3812
Practice Address - Country:US
Practice Address - Phone:215-355-4428
Practice Address - Fax:215-788-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101056578Medicaid
PA5391220001Medicare NSC
PA072967Medicare ID - Type UnspecifiedHGSA