Provider Demographics
NPI:1598239196
Name:VANTAGE EYECARE, LLC
Entity Type:Organization
Organization Name:VANTAGE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-812-4539
Mailing Address - Street 1:319 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3811
Mailing Address - Country:US
Mailing Address - Phone:856-596-1601
Mailing Address - Fax:856-983-0396
Practice Address - Street 1:775 ROUTE 70 E STE F180
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2367
Practice Address - Country:US
Practice Address - Phone:856-596-1601
Practice Address - Fax:856-983-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty