Healthcare Provider Details

I. General information

NPI: 1326156779
Provider Name (Legal Business Name): LAUREL EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 BROAD ST STE 4
NEW BETHLEHEM PA
16242-1304
US

IV. Provider business mailing address

363 BROAD ST STE 4
NEW BETHLEHEM PA
16242-1304
US

V. Phone/Fax

Practice location:
  • Phone: 814-275-2030
  • Fax:
Mailing address:
  • Phone: 814-275-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOLYNN COOK
Title or Position: ADMINISTRATOR
Credential:
Phone: 814-849-8344