MEDICARE: CHELISE FIRMIN O.D.

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	OET008924	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1245235035	OTHER	PA	MEDICARE

General Provider Information

NPI Number	:	1245235035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELISE FIRMIN O.D.

Provider Business Mailing Address
First Line	:	7016 OLD YORK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126
Country	:	US
Telephone Number	:	215-254-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	7016 OLD YORK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2111
Country	:	US
Telephone Number	:	215-254-0092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/30/2011

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