Healthcare Provider Details

I. General information

NPI: 1295874865
Provider Name (Legal Business Name): TIMOTHY BENNETT SAGGES ABOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S 20TH ST EYE CANDY VISION
PHILADELPHIA PA
19103-5616
US

IV. Provider business mailing address

218 S 20TH ST EYE CANDY VISION
PHILADELPHIA PA
19103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 215-568-3937
  • Fax: 215-568-3959
Mailing address:
  • Phone: 215-568-3937
  • Fax: 215-568-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: