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General NPI Number Information
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NPI Number | 1689891368
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR EYECARE INC.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 2979 LINCOLN HWY
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City | SADSBURYVILLE
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State | PA
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Zip | 19369
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Country | US
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Telephone | 610-857-2291
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Fax | 610-857-2297
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Provider Business Mailing Address
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Address Line | PO BOX 599 2979 LINCOLN HWY
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City | SADSBURYVILLE
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State | PA
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Zip | 19369-0599
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Country | US
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Telephone | 610-857-2291
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Fax | 610-857-2297
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | MR. DAVID WILLIAM SULAK
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Credential | O.D.
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Telephone | 215-872-0827
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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 | OEG001443
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License Number State | PA
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