MEDICARE: DELAWARE EYE CARE CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1043726532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAWARE EYE CARE CENTER PA

Provider Business Mailing Address
First Line	:	833 S GOVERNORS AVE
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-4158
Country	:	US
Telephone Number	:	302-674-1121
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S MAIN ST STE 217
Second Line	:
City	:	SMYRNA
State	:	DE
Zip	:	19977-1479
Country	:	US
Telephone Number	:	302-653-9200
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	MR. MICHAEL FRICKE
Credential	:
Telephone Number	:	302-653-9200

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	12/19/2017

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Directions to “DELAWARE EYE CARE CENTER PA ” Practice Location

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