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General NPI Number Information
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NPI Number | 1568480424
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Entity Type | Organization
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Legal Business Name | WEST PHILADELPHIA EYE ASSOC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 S 54TH ST SUITE 25
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1900
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Country | US
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Telephone | 215-748-0185
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Fax | 215-748-0180
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Provider Business Mailing Address
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Address Line | 501 S 54TH ST SUITE 25
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1900
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Country | US
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Telephone | 215-748-0185
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Fax | 215-748-0180
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DAT D DUONG
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Credential | D.O.
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Telephone | 215-748-0185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | OEG000507
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License Number State | PA
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