Healthcare Provider Details

I. General information

NPI: 1316351679
Provider Name (Legal Business Name): FAMILY EYE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N READING RD
EPHRATA PA
17522-1671
US

IV. Provider business mailing address

2110 HARRISBURG PIKE SUITE 215
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-735-1141
  • Fax:
Mailing address:
  • Phone: 717-735-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL PAVLICA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 717-735-1141