Healthcare Provider Details

I. General information

NPI: 1548513757
Provider Name (Legal Business Name): GREGG FAMILY EYE CARE RPLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 PROVIDENCE RD
SECANE PA
19018-2802
US

IV. Provider business mailing address

1266 PROVIDENCE RD
SECANE PA
19018-2802
US

V. Phone/Fax

Practice location:
  • Phone: 610-543-1219
  • Fax: 610-543-1524
Mailing address:
  • Phone: 610-543-1219
  • Fax: 610-543-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG001809
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOEG001809
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001809
License Number StatePA

VIII. Authorized Official

Name: DR. ERIC MATTHEW GREGG
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 610-543-1219