Provider Demographics
NPI:1104141035
Name:BISSELL EYE CARE, LLC
Entity type:Organization
Organization Name:BISSELL EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-882-4561
Mailing Address - Street 1:5900 HECKERT RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15007-1002
Mailing Address - Country:US
Mailing Address - Phone:724-443-6767
Mailing Address - Fax:724-443-6730
Practice Address - Street 1:5900 HECKERT RD
Practice Address - Street 2:
Practice Address - City:BAKERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15007-1002
Practice Address - Country:US
Practice Address - Phone:724-443-6767
Practice Address - Fax:724-443-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-04
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV00619Medicare UPIN