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General NPI Number Information
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NPI Number | 1235873522
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Entity Type | Organization
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Legal Business Name | IMG OPTICAL
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 04/23/2022
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Provider Practice Location Address
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Address Line | 330 W OREGON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-4723
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Country | US
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Telephone | 717-254-5507
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Fax |
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Provider Business Mailing Address
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Address Line | 330 W OREGON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-4723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KAMINDER SINGH
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Credential | OPTICI7
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Telephone | 717-254-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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