Healthcare Provider Details

I. General information

NPI: 1306352893
Provider Name (Legal Business Name): DELAWARE EYE CARE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18791 JOHN J WILLIAMS HWY
REHOBOTH BEACH DE
19971-4401
US

IV. Provider business mailing address

833 S GOVERNORS AVE
DOVER DE
19904-4158
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-2300
  • Fax:
Mailing address:
  • Phone: 302-674-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL FRICKE
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 844-377-6468