=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932521341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YARDLEY EYE CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2014
-----------------------------------------------------
Last Update Date | 01/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1581 BIG OAK RD OXFORD OAKS SHOPPING CENTER
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-6418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-369-3937
-----------------------------------------------------
Fax | 267-573-4544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1581 BIG OAK RD OXFORD OAKS SHOPPING CENTER
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-6418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-369-3937
-----------------------------------------------------
Fax | 267-573-4544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | DR. BRIAN M COHEN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 215-369-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------