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General NPI Number Information
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NPI Number | 1205760048
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Entity Type | Organization
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Legal Business Name | BOSCOVS DEPARTMENT STORE LLC
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 4737 CONCORD PIKE
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City | WILMINGTON
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State | DE
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Zip | 19803-1442
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Country | US
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Telephone | 302-478-5393
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 PERKIOMEN AVE
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City | READING
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State | PA
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Zip | 19606-3946
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Country | US
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Telephone | 610-779-2000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPTICAL SERVICES
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Name | MICHAEL DERENZO
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Credential |
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Telephone | 856-759-9905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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