Healthcare Provider Details

I. General information

NPI: 1154115749
Provider Name (Legal Business Name): OCULIST CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E WYNNEWOOD RD UNIT 4
WYNNEWOOD PA
19096-2013
US

IV. Provider business mailing address

6633 GERMANTOWN AVE
PHILADELPHIA PA
19119-2293
US

V. Phone/Fax

Practice location:
  • Phone: 610-896-4542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SHANTHY BROWN
Title or Position: PROVIDER/OWNER
Credential: OD
Phone: 215-422-3636