Provider Demographics
NPI:1699833368
Name:DUFFY BROTHERS OPTICIANS
Entity Type:Organization
Organization Name:DUFFY BROTHERS OPTICIANS
Other - Org Name:DUFFY OPTICAL CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LACOVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-698-7338
Mailing Address - Street 1:2861 HOLME AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152
Mailing Address - Country:US
Mailing Address - Phone:215-698-7338
Mailing Address - Fax:215-698-0905
Practice Address - Street 1:2861 HOLME AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-698-7338
Practice Address - Fax:215-698-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0296720001Medicare UPIN
PA0296720001Medicare ID - Type Unspecified