MEDICARE: OPTOMETRY ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1063569036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOMETRY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	4392 STURBRIDGE DR
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-3674
Country	:	US
Telephone Number	:	717-652-7710
Fax Number	:	717-541-9842

Provider Business Practice Location Address
First Line	:	4392 STURBRIDGE DRIVE
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-3670
Country	:	US
Telephone Number	:	717-652-7710
Fax Number	:	717-541-9842

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BARBARA W BLOOM
Credential	:	OD
Telephone Number	:	717-652-7710

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/18/2014

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