Healthcare Provider Details

I. General information

NPI: 1821290420
Provider Name (Legal Business Name): CLARION EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E MAIN ST STE. 20
CLARION PA
16214-6278
US

IV. Provider business mailing address

1350 E MAIN ST STE. 20
CLARION PA
16214-6278
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-4862
  • Fax: 814-226-8741
Mailing address:
  • Phone: 814-226-4862
  • Fax: 814-226-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000514
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003160
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001788
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOSHUA KEITH DIEHL
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 814-226-4862