Healthcare Provider Details

I. General information

NPI: 1861447880
Provider Name (Legal Business Name): OXFORD FAMILY EYECARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 S 2ND ST
OXFORD PA
19363-1370
US

IV. Provider business mailing address

49 S 2ND ST
OXFORD PA
19363-1370
US

V. Phone/Fax

Practice location:
  • Phone: 610-932-9356
  • Fax: 610-932-3097
Mailing address:
  • Phone: 610-932-9356
  • Fax: 610-932-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000335
License Number StatePA

VIII. Authorized Official

Name: DR. MALCOLM H. KELLY JR.
Title or Position: PRESIDENT
Credential: OD
Phone: 610-932-9356