Healthcare Provider Details

I. General information

NPI: 1568920684
Provider Name (Legal Business Name): FOR ALL VISION CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

13020 BUSTLETON AVE
PHILADELPHIA PA
19116-1651
US

IV. Provider business mailing address

13020 BUSTLETON AVE
PHILADELPHIA PA
19116-1651
US

V. Phone/Fax

Practice location:
  • Phone: 215-673-1267
  • Fax: 215-673-7085
Mailing address:
  • Phone: 215-673-1267
  • Fax: 215-673-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS LYDA KONG
Title or Position: MANAGER
Credential:
Phone: 215-673-1267