Healthcare Provider Details

I. General information

NPI: 1073500724
Provider Name (Legal Business Name): IVES EYECARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N WATER STREET
WEST NEWTON PA
15089
US

IV. Provider business mailing address

145 N WATER STREET
WEST NEWTON PA
15089
US

V. Phone/Fax

Practice location:
  • Phone: 724-872-5621
  • Fax: 724-872-6660
Mailing address:
  • Phone: 724-872-5621
  • Fax: 724-872-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL FRED IVES
Title or Position: PRESIDENT
Credential: OD
Phone: 724-872-5621