Provider Demographics
NPI:1194332445
Name:TREAT, KEVIN LEE (ABOC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:TREAT
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:LAKE WINOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18625-0517
Mailing Address - Country:US
Mailing Address - Phone:570-378-3099
Mailing Address - Fax:
Practice Address - Street 1:144 BEAR HOLLOW LN
Practice Address - Street 2:
Practice Address - City:FALLS
Practice Address - State:PA
Practice Address - Zip Code:18615-7777
Practice Address - Country:US
Practice Address - Phone:570-378-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician