MEDICARE: MR. SAM KAPLAN

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	111988	PA

General Provider Information

NPI Number	:	1689989691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAM KAPLAN

Provider Business Mailing Address
First Line	:	3810 MORRELL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1915
Country	:	US
Telephone Number	:	215-632-6698
Fax Number	:	215-281-3717

Provider Business Practice Location Address
First Line	:	3810 MORRELL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1915
Country	:	US
Telephone Number	:	215-632-6698
Fax Number	:	215-281-3717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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