Basic Information
| Provider Information | |||||||||
| NPI: | 1013926146 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHESTER COUNTY OPTICIANS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 PAOLI PIKE | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106928300 | ||||||||
| FaxNumber: | 6106926007 | ||||||||
| Practice Location | |||||||||
| Address1: | 923 PAOLI PIKE | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106928300 | ||||||||
| FaxNumber: | 6106926007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6106928300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000897526 | 01 | PW | HIGHMARK BLUE SHIELD | OTHER |