Provider Demographics
NPI:1518122662
Name:NISSMAN EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NISSMAN EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-202-9663
Mailing Address - Street 1:699 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1073
Mailing Address - Country:US
Mailing Address - Phone:610-834-1800
Mailing Address - Fax:610-834-1811
Practice Address - Street 1:699 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1073
Practice Address - Country:US
Practice Address - Phone:610-834-1800
Practice Address - Fax:610-834-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0153327OtherPREFERRED CARE
PA0153327OtherCIGNA
PA2056239OtherHIGHMARK BS
PA102174852Medicaid
PA3531481000OtherBCBS
PA1941376OtherAETNA
PA7053856OtherAETNA
PA9174238OtherAETNA
PA135818Medicare UPIN