Healthcare Provider Details

I. General information

NPI: 1750179768
Provider Name (Legal Business Name): YOUR EYE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 CHESTNUT ST LBBY 105
PHILADELPHIA PA
19103-3456
US

IV. Provider business mailing address

426 MAIN ST
HARLEYSVILLE PA
19438-2350
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-8440
  • Fax: 215-567-4993
Mailing address:
  • Phone: 215-256-6735
  • Fax: 215-256-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN FORREST
Title or Position: OWNER
Credential: OD
Phone: 215-256-6735