MEDICARE: EYE CONSULTANTS OF PENNSYLVANIA, PC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	152WC0802X	Corneal and Contact Management Optometrist
3	152WL0500X	Low Vision Rehabilitation Optometrist
4	152WV0400X	Vision Therapy Optometrist
5	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician
6	207WX0107X	Retina Specialist (Ophthalmology) Physician
7	207WX0109X	Neuro-ophthalmology Physician
8	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician
9	207WX0120X	Cornea and External Diseases Specialist Physician
10	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician
11	207W00000X	Ophthalmology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1033181904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CONSULTANTS OF PENNSYLVANIA, PC

Provider Business Mailing Address
First Line	:	1 GRANITE POINT DR STE 100
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1992
Country	:	US
Telephone Number	:	610-378-1344
Fax Number	:	610-378-5169

Provider Business Practice Location Address
First Line	:	1 GRANITE POINT DR STE 100
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1992
Country	:	US
Telephone Number	:	610-378-1344
Fax Number	:	610-378-5169

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHARLES I BUSACK
Credential	:	MHA
Telephone Number	:	610-378-1348

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	06/23/2023