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General NPI Number Information
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NPI Number | 1538302096
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Entity Type | Organization
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Legal Business Name | EYECANDY OPTICAL LLC
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 2300 E LINCOLN HWY OXFORD VALLEY MALL STORE # 224
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City | LANGHORNE
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State | PA
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Zip | 19047-1824
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Country | US
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Telephone | 215-757-4111
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Fax | 215-757-0455
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Provider Business Mailing Address
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Address Line | 2300 E LINCOLN HWY OXFORD VALLEY MALL STORE # 224
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City | LANGHORNE
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State | PA
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Zip | 19047-1824
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Country | US
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Telephone | 215-757-4111
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Fax | 215-757-0455
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | MRS. TERRI HABERMAN
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Credential | O.D.
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Telephone | 215-757-4111
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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 | OEP008528
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License Number State | PA
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