Provider Demographics
NPI:1083705230
Name:DELAWARE VISION ASSOCIATES GROUP PRACTICE PA
Entity Type:Organization
Organization Name:DELAWARE VISION ASSOCIATES GROUP PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-491-2127
Mailing Address - Street 1:2060 LIMESTONE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5500
Mailing Address - Country:US
Mailing Address - Phone:302-657-0386
Mailing Address - Fax:610-337-2133
Practice Address - Street 1:601 S HENDERSON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3596
Practice Address - Country:US
Practice Address - Phone:610-491-2127
Practice Address - Fax:610-337-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02184Medicare ID - Type Unspecified
DEG02184Medicare PIN