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General NPI Number Information
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NPI Number | 1316426240
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Entity Type | Organization
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Legal Business Name | PINE VISION CARE PC
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 1018 PINE ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6069
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Country | US
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Telephone | 215-575-5198
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Fax | 215-982-1193
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Provider Business Mailing Address
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Address Line | 1018 PINE ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6069
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Country | US
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Telephone | 215-575-5198
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Fax | 215-982-1193
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Authorized Official
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Title or Position | CEO
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Name | JULIA ZYRINA
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Credential | OD
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Telephone | 215-575-5198
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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 |
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License Number State |
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