Healthcare Provider Details

I. General information

NPI: 1659051456
Provider Name (Legal Business Name): AURORA VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MONUMENT RD
PHILADELPHIA PA
19131-1600
US

IV. Provider business mailing address

134 PLYMOUTH RD UNIT 5409
PLYMOUTH MEETING PA
19462-1472
US

V. Phone/Fax

Practice location:
  • Phone: 215-220-4455
  • Fax:
Mailing address:
  • Phone: 215-834-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDY JOHN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 215-834-2563