=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497810394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRINGHOUSE EYE CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 04/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1575 POND RD SUITE 103
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-2254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-395-3937
-----------------------------------------------------
Fax | 610-395-7728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1575 POND RD SUITE 103
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-2254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-395-3937
-----------------------------------------------------
Fax | 610-395-7728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAY R FEDER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 610-395-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG1554
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------