| |
2640 W 38th St, Erie, PA 16506-4524 | |
(814) 835-8258 | |
(814) 838-0104 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 2640 W 38th St, Erie, Pennsylvania |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1407070238 | NPI | - | NPPES |
1798932 | Other | PA | HIGHMARK ASSIGNMENT ACCT |
0016006700005 | Medicaid | PA | |
997402 | Other | PA | PA BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OEG000560 (Pennsylvania) | Secondary |
207W00000X | Ophthalmology | MD061759L (Pennsylvania) | Primary |
Mailing Address | Practice Location Address |
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2640 W 38th St, Erie, PA 16506-4524 Ph: (814) 835-8258 | 2640 W 38th St, Erie, PA 16506-4524 Ph: (814) 835-8258 |