Healthcare Provider Details

I. General information

NPI: 1720262538
Provider Name (Legal Business Name): TRI COUNTY EYE PHYSICIANS & SURGEONS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SECOND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

IV. Provider business mailing address

319 SECOND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

V. Phone/Fax

Practice location:
  • Phone: 215-355-4428
  • Fax: 215-256-2584
Mailing address:
  • Phone: 215-355-4428
  • Fax: 215-256-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD031499E
License Number StatePA

VIII. Authorized Official

Name: MRS. NANCY L FISHER
Title or Position: ACCOUNTS MANAGER
Credential: C.O.A.
Phone: 215-396-4213