Provider Demographics
NPI:1053329102
Name:YOUR EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:YOUR EYE ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-256-6735
Mailing Address - Street 1:426 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-3250
Mailing Address - Country:US
Mailing Address - Phone:215-256-6735
Mailing Address - Fax:215-256-9931
Practice Address - Street 1:1810 WILMINGTON PIKE STE 13
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8180
Practice Address - Country:US
Practice Address - Phone:610-558-2760
Practice Address - Fax:610-361-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232616112OtherTAX ID