Healthcare Provider Details

I. General information

NPI: 1467629089
Provider Name (Legal Business Name): COMPLETE FAMILY EYECARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SWAMP PIKE STE 400
GILBERTSVILLE PA
19525-9307
US

IV. Provider business mailing address

1806 SWAMP PIKE STE 400
GILBERTSVILLE PA
19525-9307
US

V. Phone/Fax

Practice location:
  • Phone: 610-323-4445
  • Fax: 610-323-4377
Mailing address:
  • Phone: 610-323-4445
  • Fax: 610-323-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001556
License Number StatePA

VIII. Authorized Official

Name: DR. LORI GRAY
Title or Position: DIRECTOR
Credential: O.D.
Phone: 215-870-3010