MEDICARE: SISTAS OF VISION INC.

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	253Z00000X	In Home Supportive Care Agency	32E5D7B6F3634C0CB2BE	PA

General Provider Information

NPI Number	:	1801127139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISTAS OF VISION INC.

Provider Business Mailing Address
First Line	:	1750 N 25TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2904
Country	:	US
Telephone Number	:	215-921-5837
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 N 25TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2904
Country	:	US
Telephone Number	:	215-921-5837
Fax Number	:

Authorized Official
Title or Position	:	SUPPORTIVE CARE DIRECTOR
Name	:	MS. CONNIE MULLINS
Credential	:
Telephone Number	:	215-921-5837

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	01/27/2010

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