Provider Demographics
NPI:1528114311
Name:COMMUNITY EYE CARE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:COMMUNITY EYE CARE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE CYCLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-990-7590
Mailing Address - Street 1:2 FARM COLONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5206
Mailing Address - Country:US
Mailing Address - Phone:814-726-2303
Mailing Address - Fax:814-726-7459
Practice Address - Street 1:2 FARM COLONY DRIVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5206
Practice Address - Country:US
Practice Address - Phone:814-726-2303
Practice Address - Fax:404-305-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 163WA2000X, 163WG0000X, 163WX1100X, 207WX0200X, 207W00000X
PAMD052930L156FX1100X
PAMD065707L156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WX1100XNursing Service ProvidersRegistered NurseOphthalmicGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1548234255OtherWUEBBOLT NPI
PA1528114311Medicare PIN
PA013548NEOMedicare ID - Type UnspecifiedYOUNGER MC
PA1245341015Medicare PIN
NYAA0793Medicare PIN
PA1477569077Medicare PIN
PAF34988Medicare UPIN
PA072891NEOMedicare ID - Type UnspecifiedDITTMAN MC
PA416182NEOMedicare ID - Type UnspecifiedWUEBBOLT MC
PAU85592Medicare UPIN
NY1548234255Medicare PIN
PA1548234255OtherWUEBBOLT NPI
PAG32154Medicare UPIN
PA754646NEOMedicare ID - Type UnspecifiedBLANEY MC
PA1298440001Medicare NSC
NY1245341015Medicare PIN
NY1477569077Medicare PIN
NY1548234255Medicare PIN
PA1548234255OtherWUEBBOLT NPI
PAG32154Medicare UPIN
PA754646NEOMedicare ID - Type UnspecifiedBLANEY MC
PA1298440001Medicare NSC
NY1477569077Medicare PIN
NY1245341015Medicare PIN