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NPI Code Detail

MEDICARE: MARSHALLS CREEK VISION CENTER

MEDICARE: MARSHALLS CREEK VISION CENTER
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
1152W00000XOptometristOEG000213PA

General Provider Information

NPI Number : 1316141864
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARSHALLS CREEK VISION CENTER
Provider Business Mailing Address
First Line : 3220 GLASE RD
Second Line :
City : DANIELSVILLE
State : PA
Zip : 18038-9692
Country : US
Telephone Number : 610-837-2398
Fax Number :
Provider Business Practice Location Address
First Line : 145 PALMER PARK MALL
Second Line : PEARLE VISION
City : EASTON
State : PA
Zip : 18045-2759
Country : US
Telephone Number : 610-258-4372
Fax Number : 610-258-5878
Authorized Official
Title or Position : PRESIDENT
Name : DR. GARY JON KOKOSKY
Credential : OD
Telephone Number : 610-704-6512
Provider Enumeration Date : 06/11/2007
Last Update Date : 08/22/2020

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Directions to “MARSHALLS CREEK VISION CENTER ” Practice Location

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