Provider Demographics
NPI:1679912174
Name:DELAWARE OPHTHALMOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:DELAWARE OPHTHALMOLOGY CONSULTANTS PA
Other - Org Name:DOC OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-477-2611
Mailing Address - Street 1:3501 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4910
Mailing Address - Country:US
Mailing Address - Phone:302-477-2626
Mailing Address - Fax:302-477-2650
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-479-3937
Practice Address - Fax:302-477-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0705150002Medicare NSC