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General NPI Number Information
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NPI Number | 1851297055
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Entity Type | Organization
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Legal Business Name | SEC2 LLC
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Dates
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Enumeration Date | 10/15/2026
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Last Update Date | 10/15/2026
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Provider Practice Location Address
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Address Line | 116 S 21ST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4431
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Country | US
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Telephone | 215-372-0147
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Fax | 215-372-0157
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Provider Business Mailing Address
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Address Line | 524 S 2ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-2409
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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 | MEMBER
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Name | ROBERT STAUBLE
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Credential | OD
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Telephone | 215-372-0147
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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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