MEDICARE: NEW PATH VISION OF NORTH WALES 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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1811667280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW PATH VISION OF NORTH WALES LLC

Provider Business Mailing Address
First Line	:	205A MONTGOMERY MALL
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3905
Country	:	US
Telephone Number	:	215-362-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	205A MONTGOMERY MALL
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3905
Country	:	US
Telephone Number	:	215-362-2422
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MICHELLE CEREO
Credential	:
Telephone Number	:	315-567-8280

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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