Provider Demographics
NPI:1952732992
Name:SOUTHWESTERN EYE CENTERS, LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN EYE CENTERS, LLC
Other - Org Name:ADVANCED EYE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-583-7793
Mailing Address - Street 1:203 N REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15461-1668
Mailing Address - Country:US
Mailing Address - Phone:724-583-7793
Mailing Address - Fax:724-583-9515
Practice Address - Street 1:203 N REDWOOD ST
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-1668
Practice Address - Country:US
Practice Address - Phone:724-583-7793
Practice Address - Fax:724-583-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008720030001Medicaid
PAU08000Medicare UPIN
PA0008720030001Medicaid