Provider Demographics
NPI:1831352343
Name:AFFORDABLE EYEWEAR OF PHILADELPHIA, LLC
Entity type:Organization
Organization Name:AFFORDABLE EYEWEAR OF PHILADELPHIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-288-9560
Mailing Address - Street 1:7200 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1011
Mailing Address - Country:US
Mailing Address - Phone:215-288-9560
Mailing Address - Fax:215-288-9560
Practice Address - Street 1:7200 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1011
Practice Address - Country:US
Practice Address - Phone:215-288-9560
Practice Address - Fax:215-288-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232736038Medicare UPIN
PA4531490001Medicare NSC