Healthcare Provider Details

I. General information

NPI: 1558662460
Provider Name (Legal Business Name): EYE CONSULTANTS OF PENNSYLVANIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E WESNER RD
BLANDON PA
19510-9729
US

IV. Provider business mailing address

1 GRANITE POINT DR STE 100
WYOMISSING PA
19610-1992
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-4241
  • Fax: 610-926-8160
Mailing address:
  • Phone: 610-378-1344
  • Fax: 610-378-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES I BUSACK
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 610-378-1348