Provider Demographics
NPI:1225251168
Name:MAYFAIR EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:MAYFAIR EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-624-0416
Mailing Address - Street 1:6921 FRANKFORD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1623
Mailing Address - Country:US
Mailing Address - Phone:215-624-0416
Mailing Address - Fax:215-624-2770
Practice Address - Street 1:6921 FRANKFORD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1623
Practice Address - Country:US
Practice Address - Phone:215-624-0416
Practice Address - Fax:215-624-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
137726OtherPTAN