Provider Demographics
NPI:1861447880
Name:OXFORD FAMILY EYECARE, PC
Entity Type:Organization
Organization Name:OXFORD FAMILY EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:610-932-9356
Mailing Address - Street 1:49 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1370
Mailing Address - Country:US
Mailing Address - Phone:610-932-9356
Mailing Address - Fax:610-932-3097
Practice Address - Street 1:49 S 2ND ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1370
Practice Address - Country:US
Practice Address - Phone:610-932-9356
Practice Address - Fax:610-932-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112071OtherEYEMED ID NO.
PA5426540001OtherDMERC JURISDICTION A
PA3634856OtherAETNA HMO
PA55863OtherDAVIS VISION
PA2203236000OtherIBC HMO ID
PA4511161OtherAETNA - PPO
PA001515704OtherHIGHMARK ID
PA3634856OtherAETNA HMO
PA5426540001OtherDMERC JURISDICTION A
PAU06849Medicare UPIN