Provider Demographics
NPI:1134338106
Name:DELAWARE FAMILY EYE CENTER, LLC
Entity type:Organization
Organization Name:DELAWARE FAMILY EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-731-9000
Mailing Address - Street 1:94A OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2066
Mailing Address - Country:US
Mailing Address - Phone:302-731-9000
Mailing Address - Fax:302-731-9925
Practice Address - Street 1:94 OMEGA DR # A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2066
Practice Address - Country:US
Practice Address - Phone:302-731-9000
Practice Address - Fax:302-731-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1 0006530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036965Medicaid
DEG01613D01OtherMEDICARE SOLO PIN#
DE1000036965Medicaid