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General NPI Number Information
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NPI Number | 1659763027
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Entity Type | Organization
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Legal Business Name | BRIGHT EYES VISION, LLC
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 1230 OLD YORK RD SUITE 102
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City | HARTSVILLE
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State | PA
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Zip | 18974-2030
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Country | US
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Telephone | 814-404-7094
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 OLD YORK RD SUITE 102
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City | HARTSVILLE
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State | PA
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Zip | 18974-2030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MANAGER
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Name | HEATHER R MILLER
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Credential | OD
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Telephone | 814-404-7094
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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 | OEG002480
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License Number State | PA
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