MEDICARE: ERIC MATTHEW GREGG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG-001809	PA
2	152WC0802X	Corneal and Contact Management Optometrist	OEG-001809	PA
3	152WL0500X	Low Vision Rehabilitation Optometrist	OEG-001809	PA

General Provider Information

NPI Number	:	1265456321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MATTHEW GREGG O.D.

Provider Business Mailing Address
First Line	:	1266 PROVIDENCE RD
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2802
Country	:	US
Telephone Number	:	610-543-1219
Fax Number	:	610-543-1524

Provider Business Practice Location Address
First Line	:	1266 PROVIDENCE RD
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2802
Country	:	US
Telephone Number	:	610-543-1219
Fax Number	:	610-543-1524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/14/2012

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