Provider Demographics
NPI:1912235995
Name:PERSONAL EYES, LLC
Entity Type:Organization
Organization Name:PERSONAL EYES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOMA-PALLADINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-647-2502
Mailing Address - Street 1:1776 E LANCASTER AVE
Mailing Address - Street 2:2
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1550
Mailing Address - Country:US
Mailing Address - Phone:610-647-2502
Mailing Address - Fax:610-647-2592
Practice Address - Street 1:1776 E LANCASTER AVE
Practice Address - Street 2:2
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1550
Practice Address - Country:US
Practice Address - Phone:610-647-2502
Practice Address - Fax:610-647-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA170040OtherMEDICARE PTAN