Basic Information
| Provider Information | |||||||||
| NPI: | 1053541342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE CANDY OPTICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4007 WASHINGTON ROAD | ||||||||
| Address2: | DONALDSON'S CROSSROADS | ||||||||
| City: | MCMURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249415100 | ||||||||
| FaxNumber: | 7249415380 | ||||||||
| Practice Location | |||||||||
| Address1: | 4007 WASHINGTON RD | ||||||||
| Address2: | DONALDSON'S CROSSROADS | ||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249415100 | ||||||||
| FaxNumber: | 7249415380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 07/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | MARCZAK | ||||||||
| AuthorizedOfficialFirstName: | MONIKA | ||||||||
| AuthorizedOfficialMiddleName: | AGNIESZKA | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIS | ||||||||
| AuthorizedOfficialTelephone: | 7249415100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OEG001269 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.