Provider Demographics
NPI:1497749923
Name:EMSLIE, DOUGLAS A (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:EMSLIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 LOWER ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2737
Mailing Address - Country:US
Mailing Address - Phone:215-946-2728
Mailing Address - Fax:
Practice Address - Street 1:184 LOWER ORCHARD DR.
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-5526
Practice Address - Country:US
Practice Address - Phone:215-946-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006398T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP27043Medicare UPIN
PA0127220001Medicare NSC
PA007637Medicare PIN