Healthcare Provider Details

I. General information

NPI: 1508434713
Provider Name (Legal Business Name): REPPERT EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WILLOW STREET PIKE N STE 310
WILLOW STREET PA
17584-9386
US

IV. Provider business mailing address

2554 CAMAS LN
EAST PETERSBURG PA
17520-1436
US

V. Phone/Fax

Practice location:
  • Phone: 717-500-2962
  • Fax: 717-459-7457
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: TYLER REPPERT
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 717-725-7673