Provider Demographics
NPI:1063524015
Name:GARY AND JANICE PARTNERSHIP
Entity type:Organization
Organization Name:GARY AND JANICE PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-543-9275
Mailing Address - Street 1:1 N BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2527
Mailing Address - Country:US
Mailing Address - Phone:610-543-9275
Mailing Address - Fax:610-544-0567
Practice Address - Street 1:1 N BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2527
Practice Address - Country:US
Practice Address - Phone:610-543-9275
Practice Address - Fax:610-544-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0367660001Medicare NSC