Provider Demographics
NPI:1750355715
Name:OPHTHALMIC PARTNERS OF DELAWARE, PA
Entity type:Organization
Organization Name:OPHTHALMIC PARTNERS OF DELAWARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:610-660-0446
Mailing Address - Street 1:40 MONUMENT RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1700
Mailing Address - Country:US
Mailing Address - Phone:610-660-0446
Mailing Address - Fax:484-434-2793
Practice Address - Street 1:3501 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4910
Practice Address - Country:US
Practice Address - Phone:302-479-3937
Practice Address - Fax:302-454-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000494502Medicaid
PA102030226Medicaid
PA180044883Medicare PIN
PA019610FVUMedicare PIN
PA102030226Medicaid
PA180044881Medicare PIN
DE031888Medicare PIN
PAB40519Medicare UPIN