Provider Demographics
NPI:1386674042
Name:FORREST, PAUL THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:FORREST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9702
Mailing Address - Country:US
Mailing Address - Phone:215-997-4535
Mailing Address - Fax:215-997-4537
Practice Address - Street 1:2339 N BROAD ST
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9702
Practice Address - Country:US
Practice Address - Phone:215-997-4535
Practice Address - Fax:215-997-4537
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007014T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA68633OtherAETNA
PA4356965OtherAETNA PPO
PA456899OtherBLUE CROSS BLUE SHIELD
PA0157937000OtherKEYSTONE
PA68633OtherAETNA
PA4356965OtherAETNA PPO