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General NPI Number Information
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NPI Number | 1982054870
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL VISION CENTER INC.
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 1017 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4213
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Country | US
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Telephone | 215-922-0212
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Fax | 215-922-6683
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Provider Business Mailing Address
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Address Line | 1017 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4213
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Country | US
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Telephone | 215-922-0212
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Fax | 215-922-6683
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN TANG
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Credential |
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Telephone | 215-922-0212
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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 | 658511
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License Number State | PA
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