Provider Demographics
NPI:1760627046
Name:EYECARE-EYEWEAR CENTER, P.C.
Entity type:Organization
Organization Name:EYECARE-EYEWEAR CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUSS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:717-576-5701
Mailing Address - Street 1:1093 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-2159
Mailing Address - Country:US
Mailing Address - Phone:717-944-4031
Mailing Address - Fax:717-944-1890
Practice Address - Street 1:1093 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-2159
Practice Address - Country:US
Practice Address - Phone:717-944-4031
Practice Address - Fax:717-944-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6272950001Medicare NSC
PA021139ZC38Medicare PIN