1861447880 NPI number — OXFORD FAMILY EYECARE, PC

Table of content: (NPI 1861447880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861447880 NPI number — OXFORD FAMILY EYECARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD FAMILY EYECARE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861447880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 S 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19363-1370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-932-9356
Provider Business Mailing Address Fax Number:
610-932-3097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19363-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-932-9356
Provider Business Practice Location Address Fax Number:
610-932-3097
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
MALCOLM
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-932-9356

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000335 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112071 . This is a "EYEMED ID NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5426540001 . This is a "DMERC JURISDICTION A" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3634856 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 55863 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2203236000 . This is a "IBC HMO ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4511161 . This is a "AETNA - PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001515704 . This is a "HIGHMARK ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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