Healthcare Provider Details

I. General information

NPI: 1598027419
Provider Name (Legal Business Name): HSHC-VISION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1843 S BROAD ST
PHILADELPHIA PA
19148-2115
US

IV. Provider business mailing address

1843 S BROAD ST
PHILADELPHIA PA
19148-2115
US

V. Phone/Fax

Practice location:
  • Phone: 215-629-1353
  • Fax: 866-521-0299
Mailing address:
  • Phone: 215-629-1353
  • Fax: 866-521-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002574
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN L FERRANTE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 215-629-1353