Provider Demographics
NPI:1912005331
Name:PRIMARY EYECARE ASSOCIATES PC
Entity Type:Organization
Organization Name:PRIMARY EYECARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCPHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-675-2404
Mailing Address - Street 1:925 HORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2029
Mailing Address - Country:US
Mailing Address - Phone:215-675-2404
Mailing Address - Fax:215-672-0748
Practice Address - Street 1:925 HORSHAM RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2029
Practice Address - Country:US
Practice Address - Phone:215-675-2404
Practice Address - Fax:215-672-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAG000146152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0253900002Medicare NSC
PA572234Medicare PIN
PADP9463Medicare PIN