Provider Demographics
NPI:1881752954
Name:SUSQUEHANNA EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:SUSQUEHANNA EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SADKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-748-8900
Mailing Address - Street 1:930 BELLEFONTE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2754
Mailing Address - Country:US
Mailing Address - Phone:570-748-8900
Mailing Address - Fax:570-748-3200
Practice Address - Street 1:930 BELLEFONTE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2754
Practice Address - Country:US
Practice Address - Phone:570-748-8900
Practice Address - Fax:570-748-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025709E332B00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD4803OtherRAILROAD MEDICARE
PA0014840800007Medicaid
50002341OtherCAPITAL BLUE CROSS
PA0014840800007Medicaid