MEDICARE: ADVANCED FAMILY EYE CARE

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	OEG001165	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538527023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED FAMILY EYE CARE

Provider Business Mailing Address
First Line	:	400 7TH ST
Second Line	:
City	:	ELLWOOD CITY
State	:	PA
Zip	:	16117-2021
Country	:	US
Telephone Number	:	724-758-6338
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 7TH ST
Second Line	:
City	:	ELLWOOD CITY
State	:	PA
Zip	:	16117-2021
Country	:	US
Telephone Number	:	724-758-6338
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN R HOLLOWAY
Credential	:	O.D.
Telephone Number	:	724-758-6338

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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Directions to “ADVANCED FAMILY EYE CARE ” Practice Location

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