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NPI Code Detail

MEDICARE: EAGLE OPTOMETRIC PC

MEDICARE: EAGLE OPTOMETRIC PC
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
1152W00000XOptometristOEG000459PA

General Provider Information

NPI Number : 1295146496
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAGLE OPTOMETRIC PC
Provider Business Mailing Address
First Line : 31 S EAGLE RD
Second Line :
City : HAVERTOWN
State : PA
Zip : 19083-3340
Country : US
Telephone Number : 610-310-9946
Fax Number :
Provider Business Practice Location Address
First Line : 578 SUSQUEHANNA BLVD
Second Line :
City : HAZLE TOWNSHIP
State : PA
Zip : 18202-3233
Country : US
Telephone Number : 610-310-9946
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DAVID A CRONAUER
Credential : O.D.
Telephone Number : 610-310-9946
Provider Enumeration Date : 05/12/2014
Last Update Date : 05/12/2014

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Directions to “EAGLE OPTOMETRIC PC ” Practice Location

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