1700099330 NPI number — PHILADELPHIA VISION CENTER OF EXTON

Table of content: (NPI 1700099330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700099330 NPI number — PHILADELPHIA VISION CENTER OF EXTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILADELPHIA VISION CENTER OF EXTON
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:
1700099330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
442 W LINCOLN HWY
Provider Second Line Business Mailing Address:
FESTIVAL SHOPPING CENTER
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-363-8060
Provider Business Mailing Address Fax Number:
610-594-8448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
442 W LINCOLN HWY
Provider Second Line Business Practice Location Address:
FESTIVAL SHOPPING CENTER
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-363-8060
Provider Business Practice Location Address Fax Number:
610-594-8448
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUBIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF COMPANY
Authorized Official Telephone Number:
610-363-8060

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , 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: PH535897 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 49820 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com