Provider Demographics
NPI:1942228853
Name:SUBURBAN EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:SUBURBAN EYE ASSOCIATES, PC
Other - Org Name:SEA PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-884-8419
Mailing Address - Street 1:510 WEST AVE
Mailing Address - Street 2:PO BOX 2099
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2725
Mailing Address - Country:US
Mailing Address - Phone:215-884-8419
Mailing Address - Fax:215-884-8127
Practice Address - Street 1:510 WEST AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2725
Practice Address - Country:US
Practice Address - Phone:215-884-8419
Practice Address - Fax:215-884-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019646E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty