1659583862 NPI number — OPHTHALMIC SURGICAL ASSOCIATES

Table of content: (NPI 1659583862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659583862 NPI number — OPHTHALMIC SURGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMIC SURGICAL ASSOCIATES
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:
6
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:
1659583862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MEDICAL CENTER BLVD STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
108-745-2616
Provider Business Mailing Address Fax Number:
610-874-0318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MEDICAL CENTER BLVD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
108-745-2616
Provider Business Practice Location Address Fax Number:
610-874-0318
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-874-5261

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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