Healthcare Provider Details

I. General information

NPI: 1588619886
Provider Name (Legal Business Name): EYE OPTIONS COTTMAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 COTTMAN AVE
PHILADELPHIA PA
19149-1122
US

IV. Provider business mailing address

2139 COTTMAN AVE
PHILADELPHIA PA
19149-1122
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-1444
  • Fax: 215-745-1448
Mailing address:
  • Phone: 215-745-1444
  • Fax: 215-745-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000266
License Number StatePA

VIII. Authorized Official

Name: MR. JOSEPH M ARAUJO
Title or Position: GM
Credential:
Phone: 215-745-1444