Healthcare Provider Details

I. General information

NPI: 1568644466
Provider Name (Legal Business Name): ADVANCED EYECARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 ROUTE 611
SWIFTWATER PA
18370
US

IV. Provider business mailing address

2055 ROUTE 611
SWIFTWATER PA
18370
US

V. Phone/Fax

Practice location:
  • Phone: 570-839-2221
  • Fax: 570-839-2576
Mailing address:
  • Phone: 570-839-2221
  • Fax: 570-839-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5234646
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 2
Identifier1652796
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBCBS

VIII. Authorized Official

Name: MICHAEL TALONE
Title or Position: PRESIDENT
Credential: OD
Phone: 570-839-2221