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General NPI Number Information
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NPI Number | 1356313688
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Entity Type | Organization
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Legal Business Name | SIDNEY I & JERRY P DAVIDOFF PTR
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 2805 W CHESTER PIKE
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City | BROOMALL
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State | PA
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Zip | 19008-1827
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Country | US
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Telephone | 610-356-3933
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Fax | 610-356-3324
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Provider Business Mailing Address
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Address Line | 2805 W CHESTER PIKE PO BOX 188
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City | BROOMALL
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State | PA
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Zip | 19008-1827
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Country | US
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Telephone | 610-356-3933
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Fax | 610-356-3324
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JERRY PHILIP DAVIDOFF
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Credential | O.D.
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Telephone | 610-356-3933
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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 | OEG000157
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License Number State | PA
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