Provider Demographics
NPI:1669548905
Name:JACQUES L. SURER, JR., D.O.,PC
Entity type:Organization
Organization Name:JACQUES L. SURER, JR., D.O.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SURER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:717-843-7829
Mailing Address - Street 1:1750 5TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2607
Mailing Address - Country:US
Mailing Address - Phone:717-843-7829
Mailing Address - Fax:717-854-7718
Practice Address - Street 1:1750 5TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2607
Practice Address - Country:US
Practice Address - Phone:717-843-7829
Practice Address - Fax:717-854-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002839L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0591808Medicaid
PA0591808Medicaid
PAD98720Medicare UPIN