MEDICARE: VISUAL EYES

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	OEG000107	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2005058000	OTHER	PA	INDEPENDENCE BLUE CROSS
2	001304559	OTHER	PA	HIGHMARK BLUE SHIELD
3	7500290	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1982663548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISUAL EYES

Provider Business Mailing Address
First Line	:	1924 COUNTY LINE RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1738
Country	:	US
Telephone Number	:	215-357-9011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 COUNTY LINE RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1738
Country	:	US
Telephone Number	:	215-357-9011
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RICHARD SPROSS
Credential	:
Telephone Number	:	215-357-9011

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	04/20/2008

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Directions to “VISUAL EYES ” Practice Location

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