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General NPI Number Information
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NPI Number | 1366626160
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Entity Type | Organization
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Legal Business Name | TRI COUNTY OPTOMETRIC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 319 SECOND STREET PIKE
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-3812
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Country | US
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Telephone | 215-355-4428
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Fax | 215-355-0790
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Provider Business Mailing Address
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Address Line | 319 SECOND STREET PIKE
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-3812
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Country | US
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Telephone | 215-355-4428
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Fax | 215-355-0790
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Authorized Official
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Title or Position | CREDENTIALING
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Name | DIANE M CAMPBELL
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Credential |
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Telephone | 215-396-4211
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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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