West Penn Advance Vision Care & Optical LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG000497 Issued in PA

Legal business name

WEST PENN ADVANCE VISION CARE & OPTICAL LLC

Practice address

2576 W 8TH St
Erie, PA 16505-4416

Phone

(814) 833-1194

Fax

(814) 838-9530

NPI assigned

Sep 20, 2013

Organization subpart

No

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

Authorized official

Name

Renee Peterson, ODNPI 1174603047

Title

Optometrist/Owner

Phone

(814) 833-1194

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 2

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

• Renee Lynn Peterson, O.D.

  • Optometrist
  • Erie, PA
  • NPI 1174603047
  Medicare reassignment Authorized official
• Julie Ellen Lillie, OD

  • Optometrist
  • Erie, PA
  • NPI 1740366194
  NPD (past)

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379635200000",
    "number": "1568898690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2576 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054416",
            "telephone_number": "814-833-1194",
            "fax_number": "814-838-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2576 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054416",
            "telephone_number": "814-833-1194",
            "fax_number": "814-838-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST PENN ADVANCE VISION CARE & OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "814-833-1194",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Wenslow
• Dylan Hunter Orris Wentz
• Jessica May Weryha, CRNP
• Darlene Wesley
• Wesleyville Hose Company No 1
• West Penn Optical Inc.
• West Ridge Family Dental, P.C.
• West Ten Podiatry Centre, Inc.
• Western Reserve SNF Operating Company LLC
• Megan Westfall, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; 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.