Provider Demographics
NPI:1013926146
Name:CHESTER COUNTY OPTICIANS, INC
Entity Type:Organization
Organization Name:CHESTER COUNTY OPTICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-692-8300
Mailing Address - Street 1:923 PAOLI PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4527
Mailing Address - Country:US
Mailing Address - Phone:610-692-8300
Mailing Address - Fax:610-692-6007
Practice Address - Street 1:923 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4527
Practice Address - Country:US
Practice Address - Phone:610-692-8300
Practice Address - Fax:610-692-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW000897526OtherHIGHMARK BLUE SHIELD
PW000897526OtherHIGHMARK BLUE SHIELD