Provider Demographics
NPI:1992713184
Name:OPTOMETRIC CARE, INC
Entity type:Organization
Organization Name:OPTOMETRIC CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-378-8585
Mailing Address - Street 1:2576 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4380
Mailing Address - Country:US
Mailing Address - Phone:724-378-8585
Mailing Address - Fax:724-375-1574
Practice Address - Street 1:539 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3548
Practice Address - Country:US
Practice Address - Phone:412-766-8875
Practice Address - Fax:412-766-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000668152W00000X
PAOEG001209152W00000X
PAOEG000767152W00000X
PAOEG000609152W00000X
PAMD044348L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410049399OtherPALMETTO GBA - RR MEDICAR
PA0009741930010Medicaid
PA990014792OtherPALMETTO GBA- RR MEDICARE
PA00974193Medicaid
PA410022561OtherPALMETTO GBA- RR MEDICARE
PA137798OtherHEALTH AMERICA
PA030648OtherHIGHMARK BLUE CROSS BLUE
PA410021871OtherPALMETTO GBA- RR MEDICARE
PA580000485OtherPALMETTO GBA-RR MEDICARE
PACK0439OtherPALMETTO GBA-RR MEDICARE
PA410019681OtherPALMETTO GBA -RAILROADMED
PA71433OtherAETNA USHC
PA=========OtherUPMC
PA410022561OtherPALMETTO GBA- RR MEDICARE
PA00974193Medicaid