MEDICARE: ALPHA OPTICAL GLEN MILLS, LLC

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

General Provider Information

NPI Number	:	1134904519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA OPTICAL GLEN MILLS, LLC

Provider Business Mailing Address
First Line	:	103 DICKENS CT
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1622
Country	:	US
Telephone Number	:	267-481-2360
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EVERGREEN DR STE 117
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-1056
Country	:	US
Telephone Number	:	610-558-9803
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GRETCHEN J BREWER
Credential	:	OD
Telephone Number	:	267-481-2360

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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