MEDICARE: GREGG FAMILY EYE CARE RPLLC

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	152WC0802X	Corneal and Contact Management Optometrist	OEG001809	PA
2	152WL0500X	Low Vision Rehabilitation Optometrist	OEG001809	PA
3	152W00000X	Optometrist	OEG001809	PA

General Provider Information

NPI Number	:	1548513757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGG FAMILY EYE CARE RPLLC

Provider Business Mailing Address
First Line	:	1266 PROVIDENCE RD
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2802
Country	:	US
Telephone Number	:	610-543-1219
Fax Number	:	610-543-1524

Provider Business Practice Location Address
First Line	:	1266 PROVIDENCE RD
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2802
Country	:	US
Telephone Number	:	610-543-1219
Fax Number	:	610-543-1524

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. ERIC MATTHEW GREGG
Credential	:	O.D.
Telephone Number	:	610-543-1219

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	04/24/2014

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