1003862459 NPI number — OPHTHALMOLOGY PHYSICIANS & SURGEONS

Table of content: (NPI 1003862459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003862459 NPI number — OPHTHALMOLOGY PHYSICIANS & SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMOLOGY PHYSICIANS & SURGEONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003862459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 WOODBOURNE RD
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19057-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-547-1818
Provider Business Mailing Address Fax Number:
215-547-5174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 N YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19040-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-672-4300
Provider Business Practice Location Address Fax Number:
215-672-9524
Provider Enumeration Date:
05/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRASS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
215-672-4300

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OE5457P , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD038937E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102934897-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".