1225251168 NPI number — MAYFAIR EYE ASSOCIATES, PC

Table of content: (NPI 1225251168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225251168 NPI number — MAYFAIR EYE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYFAIR EYE ASSOCIATES, 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:
1225251168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6921 FRANKFORD AVE
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19135-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-624-0416
Provider Business Mailing Address Fax Number:
215-624-2770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6921 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19135-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-0416
Provider Business Practice Location Address Fax Number:
215-624-2770
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
215-624-0416

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000179 , 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: 137726 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com