Healthcare Provider Details

I. General information

NPI: 1083736441
Provider Name (Legal Business Name): EAST FALLS EYE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4189 RIDGE AVE
PHILADELPHIA PA
19129-1545
US

IV. Provider business mailing address

4189 RIDGE AVE
PHILADELPHIA PA
19129-1545
US

V. Phone/Fax

Practice location:
  • Phone: 215-844-2406
  • Fax: 215-844-6771
Mailing address:
  • Phone: 215-844-2406
  • Fax: 215-844-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG001670
License Number StatePA

VIII. Authorized Official

Name: DR. JESSE A JONES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 215-844-2406