=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578557732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRISON EYE ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2005
-----------------------------------------------------
Last Update Date | 02/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 DIVISION ST
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17110-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-233-8783
-----------------------------------------------------
Fax | 717-233-2221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 DIVISION ST
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17110-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-233-8783
-----------------------------------------------------
Fax | 717-233-2221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER TREASURER
-----------------------------------------------------
Name | JAMES A DEIBLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-233-8783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------