Healthcare Provider Details

I. General information

NPI: 1104836626
Provider Name (Legal Business Name): DELAWARE OPHTHALMOLOGY CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SILVERSIDE RD
WILMINGTON DE
19810-4910
US

IV. Provider business mailing address

3501 SILVERSIDE RD
WILMINGTON DE
19810-4910
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-2626
  • Fax: 302-477-2650
Mailing address:
  • Phone: 302-477-2611
  • Fax: 302-477-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1989019750
License Number StateDE

VIII. Authorized Official

Name: MICHAEL DONAHUE
Title or Position: IT MANGER
Credential:
Phone: 302-477-2611