Primary Eye Care Center PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0E007020T Issued in PA

Legal business name

PRIMARY EYE CARE CENTER PC

Practice address

405 S Market St
Elizabethtown, PA 17022

Phone

(717) 367-1883

Fax

(717) 367-1884

NPI assigned

Oct 31, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ty M Graden, ODNPI 1891739066

Title

Optometrist

Phone

(717) 367-1883

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Optibarn2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Optibarn

  • Optometrist
  • Elizabethtown, PA
  • NPI 1932384336
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ty M Graden, OD

  • Optometrist
  • Elizabethtown, PA
  • NPI 1891739066
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301270400000",
    "number": "1205015815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 S MARKET ST",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "17022",
            "telephone_number": "717-367-1883",
            "fax_number": "717-367-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S MARKET ST",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "17022",
            "telephone_number": "717-367-1883",
            "fax_number": "717-367-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY EYE CARE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2011-03-28",
        "status": "A",
        "authorized_official_last_name": "GRADEN",
        "authorized_official_first_name": "TY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "717-367-1883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "0E007020T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kathy Prazenica, RPH
• R3Built Physical Therapy, LLC
• Cassandra M Rawa, DPT
• Karen Ellen Reading, PTA
• Rebman Eyecare, P.C.
• Joseph Paul Rebman, OD

• Optometrist in Elizabethtown, PA
• Providers in Elizabethtown, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.