Provider Demographics
NPI:1003854613
Name:DESCANT, VIVIAN (OD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:DESCANT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4005
Mailing Address - Country:US
Mailing Address - Phone:215-357-8330
Mailing Address - Fax:215-357-9373
Practice Address - Street 1:950 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4005
Practice Address - Country:US
Practice Address - Phone:215-357-8330
Practice Address - Fax:215-357-9373
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAX002692560OtherAMERICHOICE
PA0465652000OtherAMERIHEALTH
PW0465652000OtherKEYSTONE
PA2144007OtherAETNA
PADE106053OtherBLUE CROSS AND SHIELD
PA0465652000OtherPERSONAL CHOICE
PADE1700448OtherBLUE CROSS AND SHIELD
PA0465652000OtherPERSONAL CHOICE
PA2144007OtherAETNA
PAX002692560OtherAMERICHOICE