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General NPI Number Information
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NPI Number | 1205107356
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Entity Type | Organization
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Legal Business Name | MOSHANNON VALLEY EYE CARE LLC
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Dates
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Enumeration Date | 01/21/2012
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 612 CLARA ST SUITE 1
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City | HOUTZDALE
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State | PA
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Zip | 16651-1115
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Country | US
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Telephone | 814-378-7700
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Fax | 814-378-7704
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Provider Business Mailing Address
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Address Line | 612 CLARA ST SUITE 1
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City | HOUTZDALE
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State | PA
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Zip | 16651-1115
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Country | US
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Telephone | 814-378-7700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN JOSEPH SHEDLOCK
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Credential | OD
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Telephone | 814-378-7700
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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 | OEG-002053
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG-002084
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License Number State | PA
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