Provider Demographics
NPI:1053671016
Name:RESIDENCY EYE CARE
Entity Type:Organization
Organization Name:RESIDENCY EYE CARE
Other - Org Name:OPTIMA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRMIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:267-259-9620
Mailing Address - Street 1:6331 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-1129
Mailing Address - Country:US
Mailing Address - Phone:215-548-5949
Mailing Address - Fax:
Practice Address - Street 1:6331 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1129
Practice Address - Country:US
Practice Address - Phone:215-548-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty