| |
10160 Bustleton Ave, Philadelphia, PA 19116-3749 | |
(215) 934-7655 | |
(215) 934-6278 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 10160 Bustleton Ave, Philadelphia, Pennsylvania |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1457406795 | NPI | - | NPPES |
0603090004 | Other | PA | DURABLE MEDICAL EQUIPMENT |
0009231760014 | Medicaid | PA | |
0009231760017 | Medicaid | PA | |
16795 | Other | PA | SPECTERA |
PA10000 | Other | PA | VBA |
24609 | Other | PA | SPECTERA DISPENSING |
39974 | Other | PA | DAVIS VISION |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OEG001731 (Pennsylvania) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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5001 Frankford Ave, Philadelphia, PA 19124-2619 Ph: (215) 288-5000 | 10160 Bustleton Ave, Philadelphia, PA 19116-3749 Ph: (215) 934-7655 |