=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548325863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISE BETH CINER O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2805 W CHESTER PIKE
-----------------------------------------------------
City | BROOMALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19008-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-356-3933
-----------------------------------------------------
Fax | 610-356-3324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 MAPLE AVE
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004-3128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-667-3150
-----------------------------------------------------
Fax | 215-276-6196
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Optometrist
-----------------------------------------------------
License Number | OEG 1860
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WV0400X
-----------------------------------------------------
Taxonomy Name | Vision Therapy Optometrist
-----------------------------------------------------
License Number | OEG 1860
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------