Provider Demographics
NPI:1548513757
Name:GREGG FAMILY EYE CARE RPLLC
Entity type:Organization
Organization Name:GREGG FAMILY EYE CARE RPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-543-1219
Mailing Address - Street 1:1266 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2802
Mailing Address - Country:US
Mailing Address - Phone:610-543-1219
Mailing Address - Fax:610-543-1524
Practice Address - Street 1:1266 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2802
Practice Address - Country:US
Practice Address - Phone:610-543-1219
Practice Address - Fax:610-543-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001809152WC0802X, 152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104151YU7XMedicare PIN
PAV10423Medicare UPIN
PA7056360001Medicare NSC