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General NPI Number Information
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NPI Number | 1073621728
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Entity Type | Organization
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Legal Business Name | LOGIC EYECARE INC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 6101 LIMEKILN PIKE MEDICAL SUITE
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City | PHILADELPHIA
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State | PA
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Zip | 19141
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Country | US
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Telephone | 215-548-2010
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Fax | 215-548-2130
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Provider Business Mailing Address
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Address Line | 1137 E MOUNT PLEASANT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-2901
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Country | US
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Telephone | 215-548-2010
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Fax | 215-548-2130
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Authorized Official
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Title or Position | CEO
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Name | DR. TAMARA HILL- BENNETT
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Credential | O.D.
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Telephone | 215-548-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000255
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License Number State | PA
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