| Brookhaven Vision Source | |
|
4106 Edgmont Ave, Brookhaven, PA 19015-2314 | |
| (610) 872-8989 | |
| (610) 872-5220 |
| Full Name | Brookhaven Vision Source |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 4106 Edgmont Ave, Brookhaven, Pennsylvania |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760490494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | OEG001547 (Pennsylvania) | Primary |
| 332H00000X | Eyewear Supplier | OEG001547 (Pennsylvania) | Secondary |
| Provider Name | Micaela L Small |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1619461704 PECOS PAC ID: 9739517400 Enrollment ID: I20220523001710 |
| Mailing Address | Practice Location Address |
|---|---|
| Brookhaven Vision Source 4106 Edgmont Ave, Brookhaven, PA 19015-2314 Ph: (610) 872-8989 | Brookhaven Vision Source 4106 Edgmont Ave, Brookhaven, PA 19015-2314 Ph: (610) 872-8989 |
Jacqueline Rita De Jesse, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4106 Edgmont Ave, Brookhaven, PA 19015 Phone: 610-872-8989 Fax: 610-872-5220 |
Craig A. Cassey O D P C Optometrist Medicare: Medicare Enrolled Practice Location: 4590 Edgmont Ave, Brookhaven, PA 19015 Phone: 610-872-6077 Fax: 610-872-2845 |
Dr. Craig A Cassey, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 4590 Edgmont Ave, Brookhaven, PA 19015 Phone: 610-872-6077 Fax: 610-872-2845 |
Gary E. Oliver, O.D. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4590 Edgmont Ave, Brookhaven, PA 19015 Phone: 610-872-6077 Fax: 610-872-2845 |
Dr. Oladipo O Itabiyi, O.D Optometrist Medicare: Medicare Enrolled Practice Location: 1234 Harshaw Rd, Brookhaven, PA 19015 Phone: 610-876-1744 Fax: 610-876-1744 |