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General NPI Number Information
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NPI Number | 1174949853
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Entity Type | Organization
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Legal Business Name | EAST COAST OPTICAL CO INC
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 6441 RISING SUN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5228
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Country | US
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Telephone | 215-725-4404
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Fax | 215-725-2986
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Provider Business Mailing Address
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Address Line | 6441 RISING SUN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5228
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Country | US
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Telephone | 215-725-4404
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Fax | 215-725-2986
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Authorized Official
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Title or Position | PRES,OWNER
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Name | ALAN SPEAR
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Credential |
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Telephone | 215-725-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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