Provider Demographics
NPI:1124642343
Name:TRI-CENTURY EYE CARE, PC
Entity type:Organization
Organization Name:TRI-CENTURY EYE CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KILLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-781-2020
Mailing Address - Street 1:216 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4809
Mailing Address - Country:US
Mailing Address - Phone:215-781-6793
Mailing Address - Fax:215-788-3504
Practice Address - Street 1:319 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3812
Practice Address - Country:US
Practice Address - Phone:215-355-4428
Practice Address - Fax:215-788-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008674810001Medicaid