Provider Demographics
NPI:1568480424
Name:WEST PHILADELPHIA EYE ASSOC
Entity Type:Organization
Organization Name:WEST PHILADELPHIA EYE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAT
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-748-0185
Mailing Address - Street 1:501 S 54TH ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1900
Mailing Address - Country:US
Mailing Address - Phone:215-748-0185
Mailing Address - Fax:215-748-0180
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:SUITE 25
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-0185
Practice Address - Fax:215-748-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000507152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1435485OtherPERSONAL CHOICE/BLUE CHOI
PA2119844000OtherKEYSTONE HEALTH PLAN EAST
PA2119844000OtherKEYSTONE HEALTH PLAN EAST