Pennsylvania Eye & Ear Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PENNSYLVANIA EYE & EAR SURGERY

Practice address

1 Granite Point Dr
Suite 200
Wyomissing, PA 19610-1986

Phone

(610) 685-9204

Fax

(610) 685-5308

NPI assigned

Feb 6, 2006

Organization subpart

No

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

Authorized official

Name

David L O'Donnell, M.B.A.

Title

Administrator

Phone

(610) 378-1348

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PA EYE & EAR SURGERY CENTER, LLC Other name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Pennsylvania Eye and Ear SurgeryCCN 39C0001143

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Berks E.N.T. Surgical Associates, Inc.

  • Otolaryngology Physician
  • Wyomissing, PA
  • NPI 1710959499

  Member Of

  NPD member
• Eye Consultants of Pennsylvania, PC

  • Ophthalmology Physician
  • Wyomissing, PA
  • NPI 1033181904

  Member Of

  NPD member
• Virtua - Memorial Hospital Burlington County, Inc

  • Psychiatric Hospital Unit
  • Mount Holly, NJ
  • NPI 1174529846

  Member Of

  NPD member

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1609848472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GRANITE POINT DR",
            "address_2": "SUITE 200",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196101986",
            "telephone_number": "610-685-9204",
            "fax_number": "610-685-5308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GRANITE POINT DR",
            "address_2": "SUITE 200",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196101986",
            "telephone_number": "610-685-9204",
            "fax_number": "610-685-5308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA EYE & EAR SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "610-378-1348",
        "authorized_official_credential": "M.B.A."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012118620001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PA EYE & EAR SURGERY CENTER, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• David Pelagio
• Joanna Pena
• Penn'S Commons Dental Group
• Pennsylvania CVS Pharmacy LLC
• Pennsylvania Dialysis Clinic of Reading, Inc.
• Christian Perez
• Emily Perez
• Preciosa Perez, DDS
• Rick Anthony Perez, MSW
• Ryanna Perez

• Ambulatory Surgical Clinic/Center in Wyomissing, PA
• Providers in Wyomissing, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.