Provider Demographics
NPI:1801316542
Name:ALTEMUS, REGINA HELEN (OD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:HELEN
Last Name:ALTEMUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:HELEN
Other - Last Name:GAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:100 PRESIDENTIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1108
Mailing Address - Country:US
Mailing Address - Phone:484-434-2700
Mailing Address - Fax:610-660-0419
Practice Address - Street 1:100 PRESIDENTIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:484-434-2700
Practice Address - Fax:610-660-0419
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00730800152W00000X
PAOEG003265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist