Provider Demographics
NPI:1427126267
Name:VISIONCARE LASER CENTERS OF ERIE
Entity type:Organization
Organization Name:VISIONCARE LASER CENTERS OF ERIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-454-7088
Mailing Address - Street 1:1909 WEST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4936
Mailing Address - Country:US
Mailing Address - Phone:814-454-7088
Mailing Address - Fax:814-459-5189
Practice Address - Street 1:1909 WEST 8TH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4936
Practice Address - Country:US
Practice Address - Phone:814-454-7088
Practice Address - Fax:814-459-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOB007924A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA205697OtherBCBS
4015690001Medicare ID - Type Unspecified