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General NPI Number Information
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NPI Number | 1548546195
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EYE ASSOCIATES
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 3770 DRYLAND WAY SUITE D600
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City | EASTON
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State | PA
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Zip | 18045-8353
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Country | US
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Telephone | 610-253-2299
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Fax | 610-253-2282
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Provider Business Mailing Address
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Address Line | 3770 DRYLAND WAY SUITE D600
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City | EASTON
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State | PA
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Zip | 18045-8353
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Country | US
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Telephone | 610-253-2299
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Fax | 610-253-2282
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN R. DEMKO
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Credential | O.D.
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Telephone | 570-839-2221
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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 | OEG000760
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License Number State | PA
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