Healthcare Provider Details

I. General information

NPI: 1811170848
Provider Name (Legal Business Name): SAXONBURG FAMILY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 MAIN STREET
SAXONBURG PA
16056
US

IV. Provider business mailing address

PO BOX 500
SAXONBURG PA
16056-0500
US

V. Phone/Fax

Practice location:
  • Phone: 724-352-2433
  • Fax: 724-352-8466
Mailing address:
  • Phone: 724-352-2433
  • Fax: 724-352-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000391
License Number StatePA

VIII. Authorized Official

Name: DR. JEFFREY R PETERSON
Title or Position: CEO
Credential: O.D.
Phone: 724-352-2433