Provider Demographics
NPI:1740456599
Name:HUNTINGDON VALLEY EYE CARE CONSULTANTS LTD
Entity type:Organization
Organization Name:HUNTINGDON VALLEY EYE CARE CONSULTANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-7425
Mailing Address - Street 1:1650 HUNTINGDON PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8003
Mailing Address - Country:US
Mailing Address - Phone:215-947-6660
Mailing Address - Fax:
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 150
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8003
Practice Address - Country:US
Practice Address - Phone:215-947-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG00509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1623011OtherHIGHMARK BLUE SHIELD