Provider Demographics
NPI:1619148665
Name:OPHTHALMIC PARTNERS OF PENNSYLVANIA, PC
Entity Type:Organization
Organization Name:OPHTHALMIC PARTNERS OF PENNSYLVANIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
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:570-386-5926
Mailing Address - Street 1:37 MEDICAL CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-5565
Mailing Address - Country:US
Mailing Address - Phone:570-386-5926
Mailing Address - Fax:570-386-2959
Practice Address - Street 1:37 MEDICAL CROSSING RD
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-5565
Practice Address - Country:US
Practice Address - Phone:570-386-5926
Practice Address - Fax:570-386-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010607290009Medicaid
PA0010607290009Medicaid
PA063142Medicare PIN