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General NPI Number Information
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NPI Number | 1649962796
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Entity Type | Organization
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Legal Business Name | WILLS EYE OPTICAL THREE, LLC
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 901 E 8TH AVE STE 101
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1354
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Country | US
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Telephone | 610-265-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 840 WALNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MICHAEL ALLEN
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Credential | ESQUIRE
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Telephone | 215-440-3147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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