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General NPI Number Information
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NPI Number | 1821977513
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Entity Type | Organization
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Legal Business Name | ALPHA OPTICAL ARDMORE, LLC
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 74 COULTER AVE
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City | ARDMORE
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State | PA
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Zip | 19003-2308
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Country | US
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Telephone | 610-896-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 103 DICKENS CT
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City | NORTH WALES
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State | PA
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Zip | 19454-1622
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Country | US
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Telephone | 267-481-2360
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GRETCHEN J BREWER
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Credential | OD
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Telephone | 267-218-6641
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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 |
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License Number State |
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