Provider Demographics
NPI:1912970666
Name:OPHTHALMIC PARTNERS OF PENNSYLVANIA, PC
Entity Type:Organization
Organization Name:OPHTHALMIC PARTNERS OF PENNSYLVANIA, PC
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:484-434-2700
Mailing Address - Street 1:100 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 200
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
Practice Address - Street 2:SUITE 200
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002793152W00000X
PAMD052294L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010607290012Medicaid
PACC1194Medicare PIN
PA0010607290012Medicaid