Healthcare Provider Details

I. General information

NPI: 1861036204
Provider Name (Legal Business Name): VISION INNOVATION CENTERS OF PENNSYLVANIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 AIRPORT RD STE 105
HAZLE TOWNSHIP PA
18202-3294
US

IV. Provider business mailing address

703 RUTTER AVE
KINGSTON PA
18704-4801
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-9150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARIA SCOTT
Title or Position: OWNER
Credential:
Phone: 410-571-8733