Healthcare Provider Details

I. General information

NPI: 1821135971
Provider Name (Legal Business Name): FAMILY EYE CARE WEST L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 FREDERICKSON PLACE
GREENSBURG PA
15601-9688
US

IV. Provider business mailing address

2020 FREDERICKSON PLACE
GREENSBURG PA
15601-9688
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-1121
  • Fax:
Mailing address:
  • Phone: 724-837-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000580
License Number StatePA

VIII. Authorized Official

Name: JANICE B FREDERICKSON
Title or Position: OWNER DOCTOR
Credential: OD
Phone: 724-837-1121