Provider Demographics
NPI:1457584617
Name:THE EYE CARE CONNECTION, INC.
Entity Type:Organization
Organization Name:THE EYE CARE CONNECTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:GOGOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-442-1300
Mailing Address - Street 1:5351 LINCOLN HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9468
Mailing Address - Country:US
Mailing Address - Phone:717-442-1300
Mailing Address - Fax:717-442-1064
Practice Address - Street 1:5351 LINCOLN HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9468
Practice Address - Country:US
Practice Address - Phone:717-442-1300
Practice Address - Fax:717-442-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2651259OtherAETNA
930316OtherEYEMED
PA53792OtherDAVIS VISION
PAPA08206OtherVBA
PA381737OtherBLUE CROSS/ BLUE SHIELD
PA397049OtherNVA
PA381737OtherBLUE CROSS/ BLUE SHIELD
PA397049OtherNVA
PA=========OtherVSP