MEDICARE: ART OF EYECARE, 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
1	152W00000X	Optometrist	OEG000129	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427700	OTHER	PA	BLUE CROSS/BLUE SHIELD
2	347708	OTHER	PA	HEALTH AMERICA

General Provider Information

NPI Number	:	1629156823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ART OF EYECARE, PC

Provider Business Mailing Address
First Line	:	2151 SHENANGO VALLEY FWY
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2586
Country	:	US
Telephone Number	:	814-734-6464
Fax Number	:	814-734-6363

Provider Business Practice Location Address
First Line	:	2151 SHENANGO VALLEY FWY
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2586
Country	:	US
Telephone Number	:	724-346-5516
Fax Number	:	724-347-5040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES BERTON PAULSON
Credential	:	OD
Telephone Number	:	814-734-6464

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	05/11/2011

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Directions to “ART OF EYECARE, PC ” Practice Location

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