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General NPI Number Information
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NPI Number | 1104802404
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Entity Type | Individual
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Provider Name | IRA CHARLES ZEITLIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 3935 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3110
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Country | US
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Telephone | 215-386-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 3935 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3181
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Country | US
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Telephone | 215-386-6200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OE005729T
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License Number State | PA
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