Provider Demographics
NPI:1760517361
Name:MELTZER, LEE R
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:R
Last Name:MELTZER
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 1:7200 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1011
Mailing Address - Country:US
Mailing Address - Phone:215-288-9560
Mailing Address - Fax:
Practice Address - Street 1:7200 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1011
Practice Address - Country:US
Practice Address - Phone:215-288-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4531490001Medicare NSC
PA23-2736038Medicare UPIN