MEDICARE: HAZLETON EYE CENTER, INC.

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	OEG001270	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	788699	OTHER	PA	MEDICARE PTAN

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	:	1578502431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZLETON EYE CENTER, INC.

Provider Business Mailing Address
First Line	:	1201A NORTH CHURCH STREET
Second Line	:	SUITE 100
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-1443
Country	:	US
Telephone Number	:	570-454-6302
Fax Number	:	570-454-3564

Provider Business Practice Location Address
First Line	:	1201A N CHURCH ST
Second Line	:	SUITE 100
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-1443
Country	:	US
Telephone Number	:	570-454-6302
Fax Number	:	570-454-3564

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. TAMI A. BINDAS
Credential	:
Telephone Number	:	570-454-6302

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	05/18/2012

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Directions to “HAZLETON EYE CENTER, INC. ” Practice Location

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