Basic Information
| Provider Information | |||||||||
| NPI: | 1083705230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELAWARE VISION ASSOCIATES GROUP PRACTICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 LIMESTONE RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026570386 | ||||||||
| FaxNumber: | 6103372133 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S HENDERSON RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194063596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104912127 | ||||||||
| FaxNumber: | 6103372133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 12/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6104912127 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.