MEDICARE: WEST CHESTER OPTOMETRY, P.C.

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	OEG-001886	PA

General Provider Information

NPI Number	:	1275845273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST CHESTER OPTOMETRY, P.C.

Provider Business Mailing Address
First Line	:	243 HAVERFORD RD
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3318
Country	:	US
Telephone Number	:	610-930-3312
Fax Number	:	610-696-1951

Provider Business Practice Location Address
First Line	:	2805 W CHESTER PIKE
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-1827
Country	:	US
Telephone Number	:	610-356-3933
Fax Number	:	610-356-3324

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JIMMY TUY NGUYEN
Credential	:	O.D.
Telephone Number	:	610-930-3312

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	01/03/2012

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