1801863915 NPI number — ACCUVISION EYE MD CAREGROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801863915 NPI number — ACCUVISION EYE MD CAREGROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCUVISION EYE MD CAREGROUP, 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:
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:
1801863915
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:
100 CHURCH RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ARDMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19003-2316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-649-7616
Provider Business Mailing Address Fax Number:
610-649-6146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CHURCH RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19003-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-7616
Provider Business Practice Location Address Fax Number:
610-649-6146
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANDO
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
610-649-7616

Provider Taxonomy Codes

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

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

  • Identifier: 0053213000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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