Provider Demographics
NPI:1982663548
Name:VISUAL EYES
Entity Type:Organization
Organization Name:VISUAL EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-357-9011
Mailing Address - Street 1:1924 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1738
Mailing Address - Country:US
Mailing Address - Phone:215-357-9011
Mailing Address - Fax:
Practice Address - Street 1:1924 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1738
Practice Address - Country:US
Practice Address - Phone:215-357-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000107152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2005058000OtherINDEPENDENCE BLUE CROSS
PA001304559OtherHIGHMARK BLUE SHIELD
PA7500290OtherAETNA
PA=========0008OtherCIGNA
PA001304559OtherHIGHMARK BLUE SHIELD
PA4433550001Medicare NSC