Provider Demographics
NPI:1003862459
Name:OPHTHALMOLOGY PHYSICIANS & SURGEONS
Entity Type:Organization
Organization Name:OPHTHALMOLOGY PHYSICIANS & SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-672-4300
Mailing Address - Street 1:1609 WOODBOURNE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1500
Mailing Address - Country:US
Mailing Address - Phone:215-547-1818
Mailing Address - Fax:215-547-5174
Practice Address - Street 1:331 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2033
Practice Address - Country:US
Practice Address - Phone:215-672-4300
Practice Address - Fax:215-672-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE5457P152W00000X
PAMD038937E207W00000X
PA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102934897-0001Medicaid
PA4961260001Medicare NSC