Healthcare Provider Details

I. General information

NPI: 1285629576
Provider Name (Legal Business Name): IVES EYECARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 OLD WILLIAM PENN HWY
MURRYSVILLE PA
15668-1923
US

IV. Provider business mailing address

4465 OLD WILLIAM PENN HWY
MURRYSVILLE PA
15668-1923
US

V. Phone/Fax

Practice location:
  • Phone: 724-733-1918
  • Fax: 724-327-0575
Mailing address:
  • Phone: 724-733-1918
  • Fax: 724-327-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001122
License Number StatePA

VIII. Authorized Official

Name: DR. PAUL FRED IVES
Title or Position: PRESIDENT
Credential: OD
Phone: 724-733-1918