Healthcare Provider Details

I. General information

NPI: 1245390087
Provider Name (Legal Business Name): SERENA COHEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SERENA SU OD

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N. LEWIS RD., SUITE 165 COLONIAL FAMILY EYECARE LLC
ROYERSFORD PA
19468-1531
US

IV. Provider business mailing address

301 N. LEWIS RD., SUITE 165 COLONIAL FAMILY EYECARE LLC
ROYERSFORD PA
19468-1531
US

V. Phone/Fax

Practice location:
  • Phone: 610-948-7000
  • Fax: 610-948-7002
Mailing address:
  • Phone: 610-948-7000
  • Fax: 610-948-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13202
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001519
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: