Healthcare Provider Details

I. General information

NPI: 1003862459
Provider Name (Legal Business Name): OPHTHALMOLOGY PHYSICIANS & SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 N YORK RD
HATBORO PA
19040-2033
US

IV. Provider business mailing address

1609 WOODBOURNE RD SUITE 303
LEVITTOWN PA
19057-1500
US

V. Phone/Fax

Practice location:
  • Phone: 215-672-4300
  • Fax: 215-672-9524
Mailing address:
  • Phone: 215-547-1818
  • Fax: 215-547-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE5457P
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD038937E
License Number StatePA

VIII. Authorized Official

Name: MRS. ROBIN L BRASS
Title or Position: BILLING MANAGER
Credential:
Phone: 215-672-4300