Provider Demographics
NPI:1952619108
Name:LEHIGH VALLEY EYE CARE ASSOCIATES
Entity type:Organization
Organization Name:LEHIGH VALLEY EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:R. DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-432-3258
Mailing Address - Street 1:2030 W TILGHMAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:610-432-3258
Mailing Address - Fax:610-289-2100
Practice Address - Street 1:2030 W TILGHMAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4354
Practice Address - Country:US
Practice Address - Phone:610-432-3258
Practice Address - Fax:610-289-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-G002155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0003330OtherAETNA
PA410004225OtherRAIL ROAD MEDICARE
PA02419600OtherCAPITAL BLUE CROSS
PAOE-G002155OtherLICENSE NUMBER
PA000764617OtherHIGHMARK BLUE SHIELD
PA0201390001OtherMEDICARE DMERC
PA020058Medicare PIN
PA000764617OtherHIGHMARK BLUE SHIELD