Provider Demographics
NPI:1447265921
Name:BRANDT EYECARE INC
Entity type:Organization
Organization Name:BRANDT EYECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-748-7751
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:947 BELLEFONTE AVE
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-0009
Mailing Address - Country:US
Mailing Address - Phone:570-748-7751
Mailing Address - Fax:570-748-3967
Practice Address - Street 1:947 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-0009
Practice Address - Country:US
Practice Address - Phone:570-748-7751
Practice Address - Fax:570-748-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0445870001Medicare NSC