MEDICARE: GRIFFITH EYE CENTER PC

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		PA
2	207W00000X	Ophthalmology Physician		PA

General Provider Information

NPI Number	:	1558676312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRIFFITH EYE CENTER PC

Provider Business Mailing Address
First Line	:	2640 W 38TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-4524
Country	:	US
Telephone Number	:	814-835-8258
Fax Number	:	814-838-0104

Provider Business Practice Location Address
First Line	:	41 S LAKE ST
Second Line	:
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1239
Country	:	US
Telephone Number	:	814-835-8258
Fax Number	:	814-838-0104

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT A. GRIFFITH
Credential	:	MD
Telephone Number	:	814-835-8258

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/18/2010

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