Provider Demographics
NPI:1871772798
Name:LIMERICK EYE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LIMERICK EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PAIST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-495-6851
Mailing Address - Street 1:649 N LEWIS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1234
Mailing Address - Country:US
Mailing Address - Phone:610-495-6851
Mailing Address - Fax:610-495-6853
Practice Address - Street 1:649 N LEWIS RD STE 120
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1234
Practice Address - Country:US
Practice Address - Phone:610-495-6851
Practice Address - Fax:610-495-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3501720000OtherBLUE CROSS/BLUE SHIELD
PA121673XWHMedicare PIN