Provider Demographics
NPI:1316092463
Name:NORTHEASTERN EYECARE NETWORK
Entity type:Organization
Organization Name:NORTHEASTERN EYECARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-668-1192
Mailing Address - Street 1:2 BALA PLZ
Mailing Address - Street 2:333 E CITY AVENUE
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-668-1192
Mailing Address - Fax:610-668-0536
Practice Address - Street 1:2 BALA PLZ
Practice Address - Street 2:333 E CITY AVENUE
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-668-1192
Practice Address - Fax:610-668-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty