Basic Information
| Provider Information | |||||||||
| NPI: | 1861447880 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OXFORD FAMILY EYECARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193631370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109329356 | ||||||||
| FaxNumber: | 6109323097 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193631370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109329356 | ||||||||
| FaxNumber: | 6109323097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | MALCOLM | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6109329356 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG000335 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 112071 | 01 | PA | EYEMED ID NO. | OTHER | 5426540001 | 01 | PA | DMERC JURISDICTION A | OTHER | 3634856 | 01 | PA | AETNA HMO | OTHER | 55863 | 01 | PA | DAVIS VISION | OTHER | 2203236000 | 01 | PA | IBC HMO ID | OTHER | 4511161 | 01 | PA | AETNA - PPO | OTHER | 001515704 | 01 | PA | HIGHMARK ID | OTHER |