MEDICARE: WICHRYK 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	OEG000242	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1017439	OTHER	PA	AETNA US HEALTHCARE
2	267858	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1902822331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHRYK EYE ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	6451 VILLAGE LN
Second Line	:	SUITE 200
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-965-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 VILLAGE LN
Second Line	:	SUITE 200
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-965-1800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTONI MICHAEL WICHRYK
Credential	:	O.D.
Telephone Number	:	610-965-1800

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/11/2014

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