Provider Demographics
NPI:1427090570
Name:SUSSEX EYE CENTER PA
Entity type:Organization
Organization Name:SUSSEX EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-856-2020
Mailing Address - Street 1:502 W MARKET ST
Mailing Address - Street 2:P.O. BOX 400
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2322
Mailing Address - Country:US
Mailing Address - Phone:302-856-2020
Mailing Address - Fax:302-856-4970
Practice Address - Street 1:502 W MARKET ST
Practice Address - Street 2:STE A
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2322
Practice Address - Country:US
Practice Address - Phone:302-856-2020
Practice Address - Fax:302-856-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000534045Medicaid
DE0000534045Medicaid
DE0924150001Medicare NSC