Provider Demographics
NPI:1750610309
Name:CENTRAL CITY EYECARE, LLC
Entity type:Organization
Organization Name:CENTRAL CITY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-873-0340
Mailing Address - Street 1:105 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2410
Mailing Address - Country:US
Mailing Address - Phone:215-873-0340
Mailing Address - Fax:215-873-0343
Practice Address - Street 1:105 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2410
Practice Address - Country:US
Practice Address - Phone:215-873-0340
Practice Address - Fax:215-873-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031384300001Medicaid
071895Medicare PIN
U85031Medicare UPIN