Provider Demographics
NPI:1689989691
Name:KAPLAN, SAM
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:KAPLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 MORRELL AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1915
Mailing Address - Country:US
Mailing Address - Phone:215-632-6698
Mailing Address - Fax:215-281-3717
Practice Address - Street 1:3810 MORRELL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1915
Practice Address - Country:US
Practice Address - Phone:215-632-6698
Practice Address - Fax:215-281-3717
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANPI1326185182Medicare UPIN