Provider Demographics
NPI:1588619886
Name:EYE OPTIONS COTTMAN, INC.
Entity Type:Organization
Organization Name:EYE OPTIONS COTTMAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-745-1444
Mailing Address - Street 1:2139 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1122
Mailing Address - Country:US
Mailing Address - Phone:215-745-1444
Mailing Address - Fax:215-745-1448
Practice Address - Street 1:2139 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1122
Practice Address - Country:US
Practice Address - Phone:215-745-1444
Practice Address - Fax:215-745-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000266152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00640312Medicaid
PA2193348000OtherINDEPENDENCE BLUE CROSS
PA2193348000OtherKEYSTONE HEALTH PLAN EAST
PA2193348000OtherKEYSTONE HEALTH PLAN EAST
PA074265Medicare PIN