Provider Demographics
NPI:1740548627
Name:CONCEPCION, SHEILA (OD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2340
Mailing Address - Country:US
Mailing Address - Phone:215-533-2595
Mailing Address - Fax:
Practice Address - Street 1:4600 ROOSEVELT BLVD
Practice Address - Street 2:SUITE A-3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2340
Practice Address - Country:US
Practice Address - Phone:215-533-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR689152W00000X
PAOEG002699152W00000X
NJ27OA00644000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist