Healthcare Provider Details

I. General information

NPI: 1144380601
Provider Name (Legal Business Name): FAMILY EYE HEALTH CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAIN ST
BRADFORD PA
16701-2004
US

IV. Provider business mailing address

20 MAIN ST
BRADFORD PA
16701-2004
US

V. Phone/Fax

Practice location:
  • Phone: 814-368-7090
  • Fax: 814-368-5855
Mailing address:
  • Phone: 814-368-7090
  • Fax: 814-368-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. VERA J KOHLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 814-368-7090