Healthcare Provider Details

I. General information

NPI: 1750278883
Provider Name (Legal Business Name): BRENDA HOXHA OPTOMETRIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EASTON RD STE 415
WYNCOTE PA
19095-2921
US

IV. Provider business mailing address

1000 EASTON RD STE 415
WYNCOTE PA
19095-2921
US

V. Phone/Fax

Practice location:
  • Phone: 215-887-6538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004253
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: