Healthcare Provider Details

I. General information

NPI: 1659583862
Provider Name (Legal Business Name): OPHTHALMIC SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD STE 104
CHESTER PA
19013-3955
US

IV. Provider business mailing address

30 MEDICAL CENTER BLVD STE 104
CHESTER PA
19013-3955
US

V. Phone/Fax

Practice location:
  • Phone: 108-745-2616
  • Fax: 610-874-0318
Mailing address:
  • Phone: 108-745-2616
  • Fax: 610-874-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHRISTOPHER A WILLIAMS
Title or Position: PRESIDENT
Credential: MD
Phone: 610-874-5261