Healthcare Provider Details

I. General information

NPI: 1407897812
Provider Name (Legal Business Name): JAMES R. FILIPPO, OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 RHAWN ST
PHILADELPHIA PA
19152-3415
US

IV. Provider business mailing address

2614 RHAWN ST
PHILADELPHIA PA
19152-3415
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-9090
  • Fax: 215-333-5225
Mailing address:
  • Phone: 215-335-9090
  • Fax: 215-333-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOEG001388
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOEG001388
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001388
License Number StatePA

VIII. Authorized Official

Name: MS. GERI A BAUMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-335-9090