Provider Demographics
NPI:1881228930
Name:VANTAGE EYECARE, LLC
Entity Type:Organization
Organization Name:VANTAGE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-396-4211
Mailing Address - Street 1:1930 S BROAD ST UNIT 16
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2328
Mailing Address - Country:US
Mailing Address - Phone:800-448-6767
Mailing Address - Fax:215-339-8103
Practice Address - Street 1:1930 S BROAD ST UNIT 16
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2328
Practice Address - Country:US
Practice Address - Phone:800-448-6767
Practice Address - Fax:215-339-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies