Provider Demographics
NPI:1790744688
Name:OPHTHALMIC ASSOCIATES OF FORT WASHINGTON
Entity Type:Organization
Organization Name:OPHTHALMIC ASSOCIATES OF FORT WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRESGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-2730
Mailing Address - Street 1:1244 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1743
Mailing Address - Country:US
Mailing Address - Phone:215-643-2730
Mailing Address - Fax:
Practice Address - Street 1:1244 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1743
Practice Address - Country:US
Practice Address - Phone:215-643-2730
Practice Address - Fax:215-643-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACN2204OtherRAILROAD MEDICARE
PACN2204OtherRAILROAD MEDICARE
PA000734Medicare ID - Type Unspecified