Provider Demographics
NPI:1154467546
Name:PAYNE OPTICIANS
Entity Type:Organization
Organization Name:PAYNE OPTICIANS
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOURDON-PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-674-5700
Mailing Address - Street 1:632 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2002
Mailing Address - Country:US
Mailing Address - Phone:215-674-5700
Mailing Address - Fax:215-674-0563
Practice Address - Street 1:632 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2002
Practice Address - Country:US
Practice Address - Phone:215-674-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0761690001Medicare NSC