Provider Demographics
NPI:1407952583
Name:ALLENTOWN VISION CENTER, PC
Entity Type:Organization
Organization Name:ALLENTOWN VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-434-1000
Mailing Address - Street 1:740 W HAMILTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-2425
Mailing Address - Country:US
Mailing Address - Phone:610-434-1000
Mailing Address - Fax:610-434-9592
Practice Address - Street 1:740 W HAMILTON ST STE 100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-2425
Practice Address - Country:US
Practice Address - Phone:610-434-1000
Practice Address - Fax:610-434-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG00358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049093Medicare ID - Type Unspecified