Provider Demographics
NPI:1588697734
Name:HERSHEY PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:HERSHEY PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILMER
Authorized Official - Last Name:MCMANAWAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:717-533-4411
Mailing Address - Street 1:1044 COCOA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1709
Mailing Address - Country:US
Mailing Address - Phone:717-533-4411
Mailing Address - Fax:717-533-3072
Practice Address - Street 1:1044 COCOA AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1709
Practice Address - Country:US
Practice Address - Phone:717-533-4411
Practice Address - Fax:717-533-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
074528Medicare ID - Type Unspecified