MEDICARE: NEURO-OPHTHALMOLOGIC ASSOCIATES PC

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	207W00000X	Ophthalmology Physician	MD031030L	PA
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0060163000	OTHER		INDEPENDENCE BLUE CROSS
4	039391	OTHER	PA	HIGHMARK BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093714420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO-OPHTHALMOLOGIC ASSOCIATES PC

Provider Business Mailing Address
First Line	:	840 WALNUT ST
Second Line	:	SUITE 930
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-928-3130
Fax Number	:	215-592-1923

Provider Business Practice Location Address
First Line	:	840 WALNUT ST
Second Line	:	SUITE 930
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-928-3130
Fax Number	:	215-592-1923

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT CHARLES SERGOTT
Credential	:	MD
Telephone Number	:	215-928-3130

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/15/2017

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