Provider Demographics
NPI:1821603028
Name:EYEWAY6
Entity type:Organization
Organization Name:EYEWAY6
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:WAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:814-269-2157
Mailing Address - Street 1:128 LAYTON LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-4018
Mailing Address - Country:US
Mailing Address - Phone:814-269-2157
Mailing Address - Fax:
Practice Address - Street 1:150 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2858
Practice Address - Country:US
Practice Address - Phone:814-269-3937
Practice Address - Fax:815-266-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty