MEDICARE: VANTAGE EYECARE, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1760954879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTAGE EYECARE, LLC

Provider Business Mailing Address
First Line	:	9880 BUSTLETON AVE STE 313
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2144
Country	:	US
Telephone Number	:	215-677-9762
Fax Number	:	215-677-6790

Provider Business Practice Location Address
First Line	:	9880 BUSTLETON AVE STE 313
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2144
Country	:	US
Telephone Number	:	215-677-9762
Fax Number	:	215-677-6790

Authorized Official
Title or Position	:	PRINCIPAL PHYSICIAN
Name	:	RICHARD B PRINCE
Credential	:
Telephone Number	:	215-396-4211

Provider Enumeration Date	:	12/31/2018
Last Update Date	:	12/31/2018

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