Healthcare Provider Details

I. General information

NPI: 1992784821
Provider Name (Legal Business Name): EYE SURGERY CENTER OF CHESTER COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JOHN ROBERT THOMAS DR
EXTON PA
19341-2656
US

IV. Provider business mailing address

140 JOHN ROBERT THOMAS DR
EXTON PA
19341-2656
US

V. Phone/Fax

Practice location:
  • Phone: 610-280-9144
  • Fax: 610-280-0797
Mailing address:
  • Phone: 610-280-9144
  • Fax: 610-280-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number11081500
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0075577000002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DEBORAH S KITZ
Title or Position: CONSULTING ADMIN. DIRECTOR
Credential: PH.D.
Phone: 610-280-9144