Provider Demographics
NPI:1467496638
Name:DELAWARE OPHTHALMOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:DELAWARE OPHTHALMOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-477-2646
Mailing Address - Street 1:3509 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4903
Mailing Address - Country:US
Mailing Address - Phone:302-479-3937
Mailing Address - Fax:302-477-2650
Practice Address - Street 1:3509 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4903
Practice Address - Country:US
Practice Address - Phone:302-479-3937
Practice Address - Fax:302-477-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989019750152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE517357Medicare PIN
PA050823Medicare PIN
NJ035939Medicare PIN
C30409Medicare PIN