MEDICARE: LIMERICK EYE ASSOCIATES, P.C.

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	OEG000342	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3501720000	OTHER	PA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1871772798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMERICK EYE ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	649 N LEWIS RD STE 120
Second Line	:
City	:	LIMERICK
State	:	PA
Zip	:	19468-1234
Country	:	US
Telephone Number	:	610-495-6851
Fax Number	:	610-495-6853

Provider Business Practice Location Address
First Line	:	649 N LEWIS RD STE 120
Second Line	:
City	:	LIMERICK
State	:	PA
Zip	:	19468-1234
Country	:	US
Telephone Number	:	610-495-6851
Fax Number	:	610-495-6853

Authorized Official
Title or Position	:	OPTOMETRIST/PRESIDENT
Name	:	DR. JASON MICHAEL PAIST
Credential	:	O.D.
Telephone Number	:	610-495-6851

Provider Enumeration Date	:	10/27/2007
Last Update Date	:	06/24/2008

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Directions to “LIMERICK EYE ASSOCIATES, P.C. ” Practice Location

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