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General NPI Number Information
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NPI Number | 1326537622
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Entity Type | Organization
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Legal Business Name | PROVISION EYE ASSOCIATES
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 653 SKIPPACK PIKE STE 132
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City | BLUE BELL
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State | PA
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Zip | 19422-1738
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Country | US
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Telephone | 215-628-2020
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Fax | 215-628-3131
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Provider Business Mailing Address
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Address Line | 653 SKIPPACK PIKE STE 132
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City | BLUE BELL
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State | PA
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Zip | 19422-1738
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Country | US
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Telephone | 215-628-2020
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Fax | 215-628-3131
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE CAPEL
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Credential | OD
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Telephone | 518-847-6186
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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 | OEG003030
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License Number State | PA
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