MEDICARE: IVES EYECARE CENTER INC

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	OEG001122	PA

Other Identifiers

#	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

General Provider Information

NPI Number	:	1073500724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVES EYECARE CENTER INC

Provider Business Mailing Address
First Line	:	145 N WATER STREET
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089
Country	:	US
Telephone Number	:	724-872-5621
Fax Number	:	724-872-6660

Provider Business Practice Location Address
First Line	:	145 N WATER STREET
Second Line	:
City	:	WEST NEWTON
State	:	PA
Zip	:	15089
Country	:	US
Telephone Number	:	724-872-5621
Fax Number	:	724-872-6660

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL FRED IVES
Credential	:	OD
Telephone Number	:	724-872-5621

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	03/12/2010

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Directions to “IVES EYECARE CENTER INC ” Practice Location

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