Provider Demographics
NPI:1083935852
Name:VIVIAN DESCANT, O.D., P.C.
Entity Type:Organization
Organization Name:VIVIAN DESCANT, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESCANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-357-8330
Mailing Address - Street 1:950 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4070
Mailing Address - Country:US
Mailing Address - Phone:215-357-8330
Mailing Address - Fax:215-357-9373
Practice Address - Street 1:950 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4070
Practice Address - Country:US
Practice Address - Phone:215-357-8330
Practice Address - Fax:215-357-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU67250Medicare UPIN
PA901480Medicare PIN