MEDICARE: BLACKSTONE VISION TROOPER

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

General Provider Information

NPI Number	:	1881446524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKSTONE VISION TROOPER

Provider Business Mailing Address
First Line	:	30 S TROOPER RD
Second Line	:
City	:	WEST NORRITON
State	:	PA
Zip	:	19403-3050
Country	:	US
Telephone Number	:	610-708-5834
Fax Number	:	610-708-5835

Provider Business Practice Location Address
First Line	:	30 S TROOPER RD
Second Line	:
City	:	WEST NORRITON
State	:	PA
Zip	:	19403-3050
Country	:	US
Telephone Number	:	610-708-5834
Fax Number	:	610-708-5835

Authorized Official
Title or Position	:	OD/OWNER
Name	:	AVANI AMIN
Credential	:	OD
Telephone Number	:	610-708-5834

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/04/2024

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Directions to “BLACKSTONE VISION TROOPER ” Practice Location

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