Provider Demographics
NPI:1063627925
Name:LAFAYETTE EYE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LAFAYETTE EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-825-3937
Mailing Address - Street 1:413 GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1816
Mailing Address - Country:US
Mailing Address - Phone:610-825-3937
Mailing Address - Fax:610-825-0381
Practice Address - Street 1:413 GERMANTOWN PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1816
Practice Address - Country:US
Practice Address - Phone:610-825-3937
Practice Address - Fax:610-825-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051757L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA784755Medicare ID - Type Unspecified