Provider Demographics
NPI:1306966262
Name:EYE CAR OPTICAL CENTER
Entity type:Organization
Organization Name:EYE CAR OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ALFANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:610-622-0310
Mailing Address - Street 1:1004 PINE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5284
Mailing Address - Country:US
Mailing Address - Phone:610-431-4545
Mailing Address - Fax:610-622-0310
Practice Address - Street 1:925 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2920
Practice Address - Country:US
Practice Address - Phone:610-622-0310
Practice Address - Fax:610-622-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9155210332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
0126610001Medicare ID - Type Unspecified