Healthcare Provider Details

I. General information

NPI: 1700956034
Provider Name (Legal Business Name): LAUREL EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WATERFORD PIKE
BROOKVILLE PA
15825-2518
US

IV. Provider business mailing address

50 WATERFORD PIKE
BROOKVILLE PA
15825-2518
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-8344
  • Fax: 814-849-7130
Mailing address:
  • Phone: 814-849-8344
  • Fax: 814-849-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS D NICHAMIN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 814-849-8344