Healthcare Provider Details

I. General information

NPI: 1679763148
Provider Name (Legal Business Name): THOMAS M LERRO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 W CHESTER PIKE SUITE 180
NEWTOWN SQUARE PA
19073-4280
US

IV. Provider business mailing address

3475 W CHESTER PIKE SUITE 180
NEWTOWN SQUARE PA
19073-4280
US

V. Phone/Fax

Practice location:
  • Phone: 610-356-6781
  • Fax: 610-356-6781
Mailing address:
  • Phone: 610-356-6781
  • Fax: 610-356-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberNA
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS M LERRO
Title or Position: OWNER/MANAGER
Credential:
Phone: 610-356-6781