Provider Demographics
NPI:1992470769
Name:VISUALEYES, PLLC
Entity type:Organization
Organization Name:VISUALEYES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:HILTERMAN
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-920-5010
Mailing Address - Street 1:7376 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1405
Mailing Address - Country:US
Mailing Address - Phone:814-873-0792
Mailing Address - Fax:
Practice Address - Street 1:1600 PENINSULA DR STE 15
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4261
Practice Address - Country:US
Practice Address - Phone:814-920-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0076225210002Medicaid