Provider Demographics
NPI:1013950732
Name:EXTON VISION CENTER ,LLC
Entity Type:Organization
Organization Name:EXTON VISION CENTER ,LLC
Other - Org Name:EXTON VISION CENTER ,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ONWER/OD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-363-6203
Mailing Address - Street 1:121 JOHN ROBERT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2654
Mailing Address - Country:US
Mailing Address - Phone:610-363-6203
Mailing Address - Fax:610-363-6226
Practice Address - Street 1:121 JOHN ROBERT THOMAS DRIVE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2654
Practice Address - Country:US
Practice Address - Phone:610-363-6203
Practice Address - Fax:610-363-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty