Basic Information
| Provider Information | |||||||||
| NPI: | 1598808461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALLANAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 AMALIE CT | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189664904 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 NESHAMINY MALL | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190201600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159538483 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OE-006222T | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.