Provider Demographics
NPI:1467418822
Name:PHOENIXVILLE EYE ASSOCIATES
Entity Type:Organization
Organization Name:PHOENIXVILLE EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FABRIZIANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-933-1144
Mailing Address - Street 1:286 GRIFFEN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4448
Mailing Address - Country:US
Mailing Address - Phone:610-933-1144
Mailing Address - Fax:
Practice Address - Street 1:286 GRIFFEN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4448
Practice Address - Country:US
Practice Address - Phone:610-933-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE6000265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1113878Medicaid
PA730956Medicare PIN
PA0737500001Medicare NSC