Provider Demographics
NPI:1407901655
Name:JB POPIVCHAK INC
Entity Type:Organization
Organization Name:JB POPIVCHAK INC
Other - Org Name:WETHERILL OPTICIANS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BASIL
Authorized Official - Last Name:POPIVCHAK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:215-345-0401
Mailing Address - Street 1:10 W OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4209
Mailing Address - Country:US
Mailing Address - Phone:215-345-0401
Mailing Address - Fax:
Practice Address - Street 1:10 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4209
Practice Address - Country:US
Practice Address - Phone:215-345-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA81119717332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJ 288190OtherHIGHMARK CLARITY VISION#
PA36899OtherDAVIS VISION PANEL#
PA1256890001Medicare NSC