Provider Demographics
NPI:1609353291
Name:EYE AND FACIAL PLASTIC SURGERY CONSULTANTS LLC
Entity Type:Organization
Organization Name:EYE AND FACIAL PLASTIC SURGERY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACKUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-750-9400
Mailing Address - Street 1:1111 SCHROCK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1155
Mailing Address - Country:US
Mailing Address - Phone:614-502-7240
Mailing Address - Fax:866-209-8989
Practice Address - Street 1:1203 NEWTOWN-LANGHORNE ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-9400
Practice Address - Fax:215-750-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty