=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275662165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALPERN EYE ASSOCIATES, P. A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 02/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1237 QUINTILIO DR GOVENORS SQUARE PLAZA II
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701-6005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-838-0800
-----------------------------------------------------
Fax | 302-838-1644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 885 S GOVERNORS AVE
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-734-5861
-----------------------------------------------------
Fax | 302-734-1921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF INSURANCE
-----------------------------------------------------
Name | SHANNON MOGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-734-5861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------