MEDICARE: SUSQUEHANNA EYE ASSOCIATES LLC

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	025709E	PA
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD4803	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	50002341	OTHER		CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1881752954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSQUEHANNA EYE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	930 BELLEFONTE AVE
Second Line	:	SUITE 108
City	:	LOCK HAVEN
State	:	PA
Zip	:	17745-2754
Country	:	US
Telephone Number	:	570-748-8900
Fax Number	:	570-748-3200

Provider Business Practice Location Address
First Line	:	930 BELLEFONTE AVE
Second Line	:	SUITE 108
City	:	LOCK HAVEN
State	:	PA
Zip	:	17745-2754
Country	:	US
Telephone Number	:	570-748-8900
Fax Number	:	570-748-3200

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEORGE M SADKA
Credential	:	MD
Telephone Number	:	570-748-8900

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	10/20/2022

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Directions to “SUSQUEHANNA EYE ASSOCIATES LLC ” Practice Location

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