Healthcare Provider Details

I. General information

NPI: 1265328686
Provider Name (Legal Business Name): PENNSYLVANIA PHYSICIANS EYECARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5942 PEACH ST
ERIE PA
16509-3440
US

IV. Provider business mailing address

1615 S CONGRESS AVE STE 105
DELRAY BEACH FL
33445-6326
US

V. Phone/Fax

Practice location:
  • Phone: 877-350-3399
  • Fax:
Mailing address:
  • Phone: 877-350-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ALISHA JACKSON
Title or Position: SENIOR REVENUE CYCLE MANAGER
Credential:
Phone: 619-357-6146