Provider Demographics
NPI:1366404345
Name:WYOMISSING OPTOMETRIC CENTER, INC.
Entity type:Organization
Organization Name:WYOMISSING OPTOMETRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-374-3134
Mailing Address - Street 1:50 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1219
Mailing Address - Country:US
Mailing Address - Phone:610-374-3134
Mailing Address - Fax:610-374-0484
Practice Address - Street 1:50 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1219
Practice Address - Country:US
Practice Address - Phone:610-374-3134
Practice Address - Fax:610-374-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0020592000OtherKEYSTONE EAST GROUP ID#
PA02525100OtherCAPITAL BLUE CROSS GRP ID
PA0020592000OtherAMERIHEALTH GROUP ID #
PA02525100OtherKEYSTONE/SEN BLUE GRP ID#
PA29435OtherSPECTERA GROUP #
PA429305OtherHIGHMARK GROUP ID #
PA5586009OtherAETNA TRADITIONAL/PPO
PA0020592000OtherINDEPENDENCE BC/BS
PA54384OtherDAVIS AFFINITY
PA338133OtherHEALTH AMERICA/HEALTH ASSURANCE
PA5586009OtherAETNA/HMO
PA70467OtherHEALTH AMERICA GRP ID #
PACM6302OtherMEDICARE RAILROAD
PA=========OtherDEVON
PA70467OtherHEALTH AMERICA GRP ID #
PA=========OtherGEISINGER HEALTH PLAN
PA0020592000OtherAMERIHEALTH GROUP ID #
PA54384OtherDAVIS AFFINITY
PA5586009OtherAETNA/HMO
PA02525100OtherKEYSTONE/SEN BLUE GRP ID#
PA5586009OtherAETNA TRADITIONAL/PPO
PA29435OtherSPECTERA GROUP #
PA5586009OtherAETNA/HMO