Provider Demographics
NPI:1669529293
Name:DESIGNER EYEGLASS, LTD
Entity type:Organization
Organization Name:DESIGNER EYEGLASS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-286-3944
Mailing Address - Street 1:1125 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-1229
Mailing Address - Country:US
Mailing Address - Phone:570-286-3944
Mailing Address - Fax:
Practice Address - Street 1:1125 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1229
Practice Address - Country:US
Practice Address - Phone:570-286-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000756441OtherBLUE SHIELD HIGHMARK
PA393870OtherNATIONAL VISION ADMINISTR
PA410047157Medicare ID - Type UnspecifiedMEDICARE RAILROAD
PA000756441OtherBLUE SHIELD HIGHMARK
PA036756Medicare PIN