Provider Demographics
NPI:1447559992
Name:BRANDYWINE EYE CENTER PA
Entity Type:Organization
Organization Name:BRANDYWINE EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-475-6500
Mailing Address - Street 1:2500 GRUBB RD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4799
Mailing Address - Country:US
Mailing Address - Phone:302-475-6500
Mailing Address - Fax:302-475-9528
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-832-0700
Practice Address - Fax:302-836-3940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDYWINE EYE CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-23
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002810332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0250540003Medicare NSC