Provider Demographics
NPI:1053504175
Name:ENLIGHTEN EYE CARE LLC
Entity Type:Organization
Organization Name:ENLIGHTEN EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOSHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALALUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-514-2449
Mailing Address - Street 1:2154 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2154 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2515
Practice Address - Country:US
Practice Address - Phone:215-514-2449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty