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General NPI Number Information
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NPI Number | 1174884944
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Entity Type | Organization
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Legal Business Name | FOX OPTICAL & GALLERY LLC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 28 E 3RD ST
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City | BETHLEHEM
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State | PA
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Zip | 18015-1304
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Country | US
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Telephone | 610-332-2400
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Fax | 610-332-2402
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Provider Business Mailing Address
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Address Line | 28 E 3RD ST
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City | BETHLEHEM
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State | PA
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Zip | 18015-1304
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Country | US
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Telephone | 610-332-2400
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Fax | 610-332-2402
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY WYNN FOX
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Credential | O.D.
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Telephone | 610-332-2400
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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 | OE006575P
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License Number State | PA
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