Provider Demographics
NPI:1174259444
Name:VISIONARY HEALTHCARE LLC
Entity Type:Organization
Organization Name:VISIONARY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORAY
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:GURKAYNAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-506-3114
Mailing Address - Street 1:11304 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1190
Mailing Address - Country:US
Mailing Address - Phone:610-506-3114
Mailing Address - Fax:215-426-7689
Practice Address - Street 1:3400 ARAMINGO AVE STE 7
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4531
Practice Address - Country:US
Practice Address - Phone:215-425-4340
Practice Address - Fax:215-426-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001452390Medicaid