Provider Demographics
NPI:1033277249
Name:NEW WORLD VISION CENTER II
Entity Type:Organization
Organization Name:NEW WORLD VISION CENTER II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:HUA
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-289-0200
Mailing Address - Street 1:813 A ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2477
Mailing Address - Country:US
Mailing Address - Phone:215-289-0200
Mailing Address - Fax:215-289-3895
Practice Address - Street 1:813 A ADAMS AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2477
Practice Address - Country:US
Practice Address - Phone:215-289-0200
Practice Address - Fax:215-289-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA182925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6347790001Medicare NSC