Provider Demographics
NPI:1609028646
Name:EYE WISE
Entity Type:Organization
Organization Name:EYE WISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HASHAAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:215-612-0340
Mailing Address - Street 1:1706 FRANKLIN MILLS CIR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3134
Mailing Address - Country:US
Mailing Address - Phone:215-612-0340
Mailing Address - Fax:215-612-0348
Practice Address - Street 1:1706 FRANKLIN MILLS CIR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3134
Practice Address - Country:US
Practice Address - Phone:215-612-0340
Practice Address - Fax:215-612-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA384661156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty