Provider Demographics
NPI:1881446524
Name:BLACKSTONE VISION TROOPER
Entity type:Organization
Organization Name:BLACKSTONE VISION TROOPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-708-5834
Mailing Address - Street 1:30 S TROOPER RD
Mailing Address - Street 2:
Mailing Address - City:WEST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3050
Mailing Address - Country:US
Mailing Address - Phone:610-708-5834
Mailing Address - Fax:610-708-5835
Practice Address - Street 1:30 S TROOPER RD
Practice Address - Street 2:
Practice Address - City:WEST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-3050
Practice Address - Country:US
Practice Address - Phone:610-708-5834
Practice Address - Fax:610-708-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty