Healthcare Provider Details

I. General information

NPI: 1366730194
Provider Name (Legal Business Name): STEPHANIE VACHARAT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ACADEMY LN
ELKINS PARK PA
19027-2514
US

IV. Provider business mailing address

1413 ACADEMY LN
ELKINS PARK PA
19027-2514
US

V. Phone/Fax

Practice location:
  • Phone: 215-782-1047
  • Fax:
Mailing address:
  • Phone: 215-782-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001542
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: