Provider Demographics
NPI:1598971632
Name:COLLINGDALE VISION CENTER LLC
Entity Type:Organization
Organization Name:COLLINGDALE VISION CENTER LLC
Other - Org Name:COLLINGDALE VISION CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-586-1506
Mailing Address - Street 1:467 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3209
Mailing Address - Country:US
Mailing Address - Phone:610-586-1506
Mailing Address - Fax:
Practice Address - Street 1:467 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3209
Practice Address - Country:US
Practice Address - Phone:610-586-1506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty