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NPI Code Detail

MEDICARE: VANTAGE EYECARE, LLC

MEDICARE: VANTAGE EYECARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1396258604
Entity Type Code : Organization
Provider Name (Legal Business Name) : VANTAGE EYECARE, LLC
Provider Business Mailing Address
First Line : 2610 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-5104
Country : US
Telephone Number : 800-448-6767
Fax Number : 215-339-8103
Provider Business Practice Location Address
First Line : 2610 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-5104
Country : US
Telephone Number : 800-448-6767
Fax Number : 215-339-8103
Authorized Official
Title or Position : PRINCIPAL PHYSICIAN
Name : RICHARD B PRINCE
Credential :
Telephone Number : 215-396-4211
Provider Enumeration Date : 11/08/2017
Last Update Date : 11/08/2017

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Directions to “VANTAGE EYECARE, LLC ” Practice Location

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