=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013286418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES CIMBAK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2011
-----------------------------------------------------
Last Update Date | 09/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 LIMEKILN PIKE STE 4
-----------------------------------------------------
City | AMBLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19002-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-619-2292
-----------------------------------------------------
Fax | 215-619-2804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 LIMEKILN PIKE STE 4
-----------------------------------------------------
City | AMBLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19002-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-619-2292
-----------------------------------------------------
Fax | 215-619-2804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES CIMBAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-619-2292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------