MEDICARE: YOUR FAMILY EYE DOCTORS, 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	OEG000583	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	704404	OTHER	PA	HIGHMARK BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1831343664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR FAMILY EYE DOCTORS, INC

Provider Business Mailing Address
First Line	:	8775 NORWIN AVE
Second Line	:
City	:	N HUNTINGDON
State	:	PA
Zip	:	15642-2718
Country	:	US
Telephone Number	:	724-864-7777
Fax Number	:	724-864-7779

Provider Business Practice Location Address
First Line	:	3520 ROUTE 130
Second Line	:	2001
City	:	IRWIN
State	:	PA
Zip	:	15642-1438
Country	:	US
Telephone Number	:	724-744-7000
Fax Number	:	724-744-7001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUSTINE A CAKANAC
Credential	:	O.D.
Telephone Number	:	724-864-7777

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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Directions to “YOUR FAMILY EYE DOCTORS, INC ” Practice Location

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