MEDICARE: ALLIED EYE CARE OF DOYLESTOWN 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
1	152W00000X	Optometrist	OEG000334	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1139923	OTHER	PA	AETNA
2	2674217000	OTHER	PA	KEYSTONE
3	2674217000	OTHER	PA	PERSONAL CHOICE

General Provider Information

NPI Number	:	1689713778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED EYE CARE OF DOYLESTOWN LLC

Provider Business Mailing Address
First Line	:	4391 W SWAMP RD
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18902-1039
Country	:	US
Telephone Number	:	215-348-3127
Fax Number	:

Provider Business Practice Location Address
First Line	:	4391 W SWAMP RD
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18902-1039
Country	:	US
Telephone Number	:	215-348-3127
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CURT ALLEN GOTTLIEB
Credential	:	OD
Telephone Number	:	215-348-3127

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	04/20/2008

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