Provider Demographics
NPI:1861219032
Name:EICHENLAUB, TERA L (ABOC NCLEC)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:L
Last Name:EICHENLAUB
Suffix:
Gender:F
Credentials:ABOC NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-4845
Mailing Address - Country:US
Mailing Address - Phone:814-693-1437
Mailing Address - Fax:
Practice Address - Street 1:200 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-4845
Practice Address - Country:US
Practice Address - Phone:814-693-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician