Basic Information
| Provider Information | |||||||||
| NPI: | 1750355715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPHTHALMIC PARTNERS OF DELAWARE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 MONUMENT RD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | BALA CYNWYD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190041700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106600446 | ||||||||
| FaxNumber: | 4844342793 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 SILVERSIDE RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198104910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024793937 | ||||||||
| FaxNumber: | 3024548810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6106600446 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0000494502 | 05 | DE | MEDICAID | 102030226 | 05 | PA | MEDICAID |