Provider Demographics
NPI:1972882942
Name:BISTLINE VISION CARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:BISTLINE VISION CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISTLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-941-0335
Mailing Address - Street 1:500 W GERMANTOWN PIKE
Mailing Address - Street 2:SPACE 2230
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1353
Mailing Address - Country:US
Mailing Address - Phone:610-941-0335
Mailing Address - Fax:610-941-9534
Practice Address - Street 1:500 W GERMANTOWN PIKE
Practice Address - Street 2:SPACE 2230
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1353
Practice Address - Country:US
Practice Address - Phone:610-941-0335
Practice Address - Fax:610-941-9534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty