=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265274658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAR EYE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2024
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 PULASKI HWY
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-678-4800
-----------------------------------------------------
Fax | 856-678-3630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 N BROADWAY
-----------------------------------------------------
City | PENNSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08070-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-678-4800
-----------------------------------------------------
Fax | 856-678-3630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. WENDY MARANDOLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-678-4800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------