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General NPI Number Information
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NPI Number | 1003896440
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Entity Type | Organization
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Legal Business Name | SOUTHERN TIER OPTOMETRIC CENTER INC
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 147 W 18TH ST
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City | ERIE
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State | PA
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Zip | 16501-2103
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Country | US
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Telephone | 814-454-7138
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Fax |
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Provider Business Mailing Address
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Address Line | 147 W 18TH ST
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City | ERIE
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State | PA
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Zip | 16501-2103
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Country | US
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Telephone | 814-454-7138
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Fax |
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Authorized Official
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Title or Position | CORPORATE BUSINESS MANAGER
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Name | MRS. SAM L ROSENSWIE
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Credential |
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Telephone | 716-372-9464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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