Provider Demographics
NPI:1225557655
Name:ALPHA OPTICAL WYOMISSING, LLC
Entity Type:Organization
Organization Name:ALPHA OPTICAL WYOMISSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-772-8121
Mailing Address - Street 1:3070 BRISTOL PIKE STE 2-220
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5361
Mailing Address - Country:US
Mailing Address - Phone:215-497-1001
Mailing Address - Fax:215-639-2486
Practice Address - Street 1:714 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3231
Practice Address - Country:US
Practice Address - Phone:484-772-8121
Practice Address - Fax:610-374-2808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA OPTICAL GROUP, LLC SOLE MEMBER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty