Provider Demographics
NPI:1700857067
Name:DAVIDOFF & ASSOCIATES INC
Entity Type:Organization
Organization Name:DAVIDOFF & ASSOCIATES INC
Other - Org Name:WHITELAND FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-430-2060
Mailing Address - Street 1:301 W BOOT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1109
Mailing Address - Country:US
Mailing Address - Phone:610-430-2060
Mailing Address - Fax:610-430-2063
Practice Address - Street 1:301 W BOOT RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1109
Practice Address - Country:US
Practice Address - Phone:610-430-2060
Practice Address - Fax:610-430-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACK2540OtherRAILROAD MEDICARE PIN
PA056726Medicare PIN