Provider Demographics
NPI:1043347792
Name:EYECARE PROFESSIONALS
Entity type:Organization
Organization Name:EYECARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:OPT
Authorized Official - Phone:717-843-8993
Mailing Address - Street 1:855 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-4934
Mailing Address - Country:US
Mailing Address - Phone:717-843-8993
Mailing Address - Fax:717-848-5217
Practice Address - Street 1:855 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4934
Practice Address - Country:US
Practice Address - Phone:717-843-8993
Practice Address - Fax:717-848-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MA1963156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA608146Medicaid