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General NPI Number Information
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NPI Number | 1841493897
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Entity Type | Organization
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Legal Business Name | CRANBERRY EYECARE LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 101 SMITH DR STE 3
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-4129
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Country | US
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Telephone | 724-776-5888
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Fax | 724-935-2900
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Provider Business Mailing Address
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Address Line | 101 SMITH DR STE 3
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-4129
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Country | US
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Telephone | 724-776-5888
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Fax | 724-935-2900
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Authorized Official
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Title or Position | PRESIDENT/SOLE MEMBER
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Name | ELMER W EBECK
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Credential | OD
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Telephone | 724-776-5888
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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 | OEG002021
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License Number State | PA
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