MEDICARE: LAUREL EYE CLINIC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF3515	OTHER		RAILROAD MEDICARE GROUP #

General Provider Information

NPI Number	:	1326156779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL EYE CLINIC

Provider Business Mailing Address
First Line	:	363 BROAD ST
Second Line	:	STE 4
City	:	NEW BETHLEHEM
State	:	PA
Zip	:	16242-1304
Country	:	US
Telephone Number	:	814-275-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 BROAD ST
Second Line	:	STE 4
City	:	NEW BETHLEHEM
State	:	PA
Zip	:	16242-1304
Country	:	US
Telephone Number	:	814-275-2030
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOLYNN COOK
Credential	:
Telephone Number	:	814-849-8344

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	10/16/2012

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Directions to “LAUREL EYE CLINIC ” Practice Location

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