Healthcare Provider Details

I. General information

NPI: 1699833368
Provider Name (Legal Business Name): DUFFY BROTHERS OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 HOLME AVENUE
PHILADELPHIA PA
19152
US

IV. Provider business mailing address

2861 HOLME AVENUE
PHILADELPHIA PA
19152
US

V. Phone/Fax

Practice location:
  • Phone: 215-698-7338
  • Fax: 215-698-0905
Mailing address:
  • Phone: 215-698-7338
  • Fax: 215-698-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEPHEN T LACOVARA
Title or Position: OWNER OFFICER
Credential:
Phone: 215-698-7338