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General NPI Number Information
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NPI Number | 1619244662
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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 | 11/18/2011
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | HC 2 BOX 1702
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-9732
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Country | US
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Telephone | 570-992-3933
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 1702
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-9732
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Country | US
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Telephone | 570-992-3933
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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. STEVEN R. DEMKO
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Credential | O.D.
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Telephone | 570-992-3933
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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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