Provider Demographics
NPI:1033445630
Name:EYE ASSOCIATES OF RICHBORO PC
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF RICHBORO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHETZLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-355-5818
Mailing Address - Street 1:56 RICHBORO NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1700
Mailing Address - Country:US
Mailing Address - Phone:215-355-5818
Mailing Address - Fax:
Practice Address - Street 1:56 RICHBORO NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1700
Practice Address - Country:US
Practice Address - Phone:215-355-5818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008850152W00000X
PAOE007643T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty