Provider Demographics
NPI:1053541342
Name:EYE CANDY OPTICAL CENTER
Entity type:Organization
Organization Name:EYE CANDY OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIS
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:AGNIESZKA
Authorized Official - Last Name:MARCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-941-5100
Mailing Address - Street 1:4007 WASHINGTON ROAD
Mailing Address - Street 2:DONALDSON'S CROSSROADS
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2520
Mailing Address - Country:US
Mailing Address - Phone:724-941-5100
Mailing Address - Fax:724-941-5380
Practice Address - Street 1:4007 WASHINGTON RD
Practice Address - Street 2:DONALDSON'S CROSSROADS
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2520
Practice Address - Country:US
Practice Address - Phone:724-941-5100
Practice Address - Fax:724-941-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001269152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU97903Medicare UPIN