MEDICARE: BISTLINE VISION CARE ASSOCIATES, PC

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	OEG002052	PA

General Provider Information

NPI Number	:	1972882942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISTLINE VISION CARE ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	500 W GERMANTOWN PIKE
Second Line	:	SPACE 2230
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1353
Country	:	US
Telephone Number	:	610-941-0335
Fax Number	:	610-941-9534

Provider Business Practice Location Address
First Line	:	500 W GERMANTOWN PIKE
Second Line	:	SPACE 2230
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1353
Country	:	US
Telephone Number	:	610-941-0335
Fax Number	:	610-941-9534

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN BISTLINE
Credential	:	O.D.
Telephone Number	:	610-941-0335

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/22/2016

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