Provider Demographics
NPI:1366566713
Name:OPTOMETRIC CARE, INC
Entity type:Organization
Organization Name:OPTOMETRIC CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OCI
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-774-7232
Mailing Address - Street 1:102 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2456
Mailing Address - Country:US
Mailing Address - Phone:724-774-7232
Mailing Address - Fax:724-774-1856
Practice Address - Street 1:102 WAGNER RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-2456
Practice Address - Country:US
Practice Address - Phone:724-774-7232
Practice Address - Fax:724-774-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001209152W00000X
PAOEG000767152W00000X
152WC0802X, 152W00000X
PAOEG000668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019390180002Medicaid
PA71433OtherAETNA
PA1392079OtherHIGHMARK BCBS MD
PW137838OtherADVANTRA HEALTH AMERICA
PA030648OtherHIGHMARK BCBS
PAPA4436OtherEYEMED
PAT28184Medicare UPIN
PA030648Medicare ID - Type Unspecified
PAPA4436OtherEYEMED
PW137838OtherADVANTRA HEALTH AMERICA
PAU10061Medicare UPIN