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General NPI Number Information
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NPI Number | 1548494768
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA VISION CENTER OF 15TH ST. INC.
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 1509 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2501
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Country | US
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Telephone | 215-568-2838
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Fax | 215-568-2515
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Provider Business Mailing Address
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Address Line | 1509 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2501
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Country | US
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Telephone | 215-568-2838
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Fax | 215-568-2515
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEIL M KABINOFF
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Credential |
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Telephone | 215-568-2838
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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 | OEG001383
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License Number State | PA
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