Central Vision Eyecare LLC
Organization Active NPI Optometrist · Milton, PA
NPI 1578034187 · NPPES record last updated May 10, 2019
Key facts
- NPI
- 1578034187
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- CENTRAL VISION EYECARE LLC
- Practice address
- 23 S Arch St
Milton, PA 17847-1124 - Phone
- (570) 412-1346
- NPI assigned
- Dec 7, 2018
- Organization subpart
- No
Authorized official
- Name
- Tera Lyn Unzicker-Fassero, O.D.
- Title
- Owner/Optometrist
- Phone
- (570) 768-4970
Practitioners 7
-
Daniel J Fassero, MD
-
Alex Lupolt, OD
-
Joshua Alan Bower, PA-C
-
Jennifer A Hoffmaster, PA-C
-
Dean Eric Wolz, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190129001034 | PA | Part B Supplier - Clinic/Group Practice | 5991042939 |
Receives reassigned benefits from 6 practitioners Practice locations: Montoursville, PA; Milton, PA; Lewisburg, PA |
National Provider Directory
Locations
416 Market St
Ste 214
Lewisburg, PA 17837
Phone (717) 417-8378
4504 Westbranch Hwy
Lewisburg, PA 17837
Phone (570) 768-4970
30 Choate Cir
Ste 2
Montoursville, PA 17754
Phone (570) 768-4970
326 N Broad St
Selinsgrove, PA 17870
Phone (570) 374-8136
Interoperability endpoints
- jbower@cve.intellechartdirect.net
- jhoffmaster@cve.intellechartdirect.net
- alupolt@cve.intellechartdirect.net
- tunzickerfassero@cve.intellechartdirect.net
- dfassero@cve.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
23 S Arch St
Milton, PA 17847-1124
Mailing address
416 Market St Ste 214
Lewisburg, PA 17837-1473
Phone (570) 768-4970
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102551143 | Medicaid | PA |
Other providers in Milton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.