Provider Demographics
NPI:1861760316
Name:DUBOIS VISION CLINIC
Entity type:Organization
Organization Name:DUBOIS VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUSE WATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-371-2020
Mailing Address - Street 1:17 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2401
Mailing Address - Country:US
Mailing Address - Phone:814-371-2020
Mailing Address - Fax:814-371-7532
Practice Address - Street 1:17 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2401
Practice Address - Country:US
Practice Address - Phone:814-371-2020
Practice Address - Fax:814-371-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87952Medicare UPIN