Healthcare Provider Details

I. General information

NPI: 1861944522
Provider Name (Legal Business Name): EYE CARE ASSOCIATE OF PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 PAOLI PIKE
WEST CHESTER PA
19380-4527
US

IV. Provider business mailing address

929 S HIGH ST
WEST CHESTER PA
19382-5466
US

V. Phone/Fax

Practice location:
  • Phone: 610-692-8300
  • Fax: 610-692-6007
Mailing address:
  • Phone: 610-692-5019
  • Fax: 610-696-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001893
License Number StatePA

VIII. Authorized Official

Name: DANIEL JOHNSTON
Title or Position: OPTOMERTRIST
Credential: OD
Phone: 610-692-5019