Provider Demographics
NPI:1912940776
Name:MAYER OPTICAL
Entity Type:Organization
Organization Name:MAYER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAGHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-922-3090
Mailing Address - Street 1:727 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2315
Mailing Address - Country:US
Mailing Address - Phone:215-922-3090
Mailing Address - Fax:
Practice Address - Street 1:27 BLACKSMITH RD STE 202
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1870
Practice Address - Country:US
Practice Address - Phone:215-497-1001
Practice Address - Fax:215-497-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA66552OtherHIGHMARK
PA0515980001OtherDME
PA66552OtherHIGHMARK