Healthcare Provider Details

I. General information

NPI: 1881752954
Provider Name (Legal Business Name): SUSQUEHANNA EYE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 BELLEFONTE AVE SUITE 108
LOCK HAVEN PA
17745-2754
US

IV. Provider business mailing address

930 BELLEFONTE AVE SUITE 108
LOCK HAVEN PA
17745-2754
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-8900
  • Fax: 570-748-3200
Mailing address:
  • Phone: 570-748-8900
  • Fax: 570-748-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number025709E
License Number StatePA

VIII. Authorized Official

Name: MR. GEORGE M SADKA
Title or Position: OWNER
Credential: MD
Phone: 570-748-8900