Healthcare Provider Details

I. General information

NPI: 1013481985
Provider Name (Legal Business Name): FOR EYES OPTICAL OF PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MACDADE BLVD
MILMONT PARK PA
19033-3204
US

IV. Provider business mailing address

3601 SW 160TH AVE STE 400
MIRAMAR FL
33027-6312
US

V. Phone/Fax

Practice location:
  • Phone: 640-522-1500
  • Fax:
Mailing address:
  • Phone: 305-557-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KIM GRIFFIN
Title or Position: MANAGER
Credential:
Phone: 305-557-9004