Provider Demographics
NPI:1801863915
Name:ACCUVISION EYE MD CAREGROUP, PC
Entity Type:Organization
Organization Name:ACCUVISION EYE MD CAREGROUP, PC
Other - Org Name:PHILADELPHIA OPHTHALMOLOGY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-649-7616
Mailing Address - Street 1:100 CHURCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2316
Mailing Address - Country:US
Mailing Address - Phone:610-649-7616
Mailing Address - Fax:610-649-6146
Practice Address - Street 1:100 CHURCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2316
Practice Address - Country:US
Practice Address - Phone:610-649-7616
Practice Address - Fax:610-649-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053213000OtherINDEPENDENCE BLUE CROSS
PA158782Medicare ID - Type Unspecified