Provider Demographics
NPI:1073738514
Name:EK OPTOMETRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:EK OPTOMETRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-265-0765
Mailing Address - Street 1:860 1ST AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-265-0765
Mailing Address - Fax:610-265-6824
Practice Address - Street 1:860 1ST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-265-0765
Practice Address - Fax:610-265-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0129910002Medicare NSC
PAT72797Medicare UPIN
PAEK444985Medicare ID - Type Unspecified