=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275761967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE EYESIGHT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2009
-----------------------------------------------------
Last Update Date | 02/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 MCKEAN AVENUE
-----------------------------------------------------
City | CHARLEROI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-483-8065
-----------------------------------------------------
Fax | 724-565-5110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 212
-----------------------------------------------------
City | CHARLEROI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-483-8065
-----------------------------------------------------
Fax | 724-565-5110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KATHLEEN CASTNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-483-8065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 020526E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD-020526-E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------