Provider Demographics
NPI:1497279095
Name:ALPHA EYE WYOMISSING, LLC
Entity Type:Organization
Organization Name:ALPHA EYE WYOMISSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-497-1001
Mailing Address - Street 1:3070 BRISTOL PIKE STE 2-220
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5361
Mailing Address - Country:US
Mailing Address - Phone:215-497-1001
Mailing Address - Fax:215-639-2486
Practice Address - Street 1:714 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3231
Practice Address - Country:US
Practice Address - Phone:610-376-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty