Provider Demographics
NPI:1972695435
Name:EYE PHYSICIANS & SURGEONS, PA
Entity Type:Organization
Organization Name:EYE PHYSICIANS & SURGEONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-652-3353
Mailing Address - Street 1:1207 N SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4059
Mailing Address - Country:US
Mailing Address - Phone:302-652-3353
Mailing Address - Fax:302-656-9979
Practice Address - Street 1:1207 N SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4059
Practice Address - Country:US
Practice Address - Phone:302-652-3353
Practice Address - Fax:302-656-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
DE207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000162502Medicaid
DE068181Medicare ID - Type Unspecified