Basic Information
| Provider Information | |||||||||
| NPI: | 1902907371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELAWARE VALLEY VISION ASSOCIATES GROUP PRACTICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1018 W 9TH AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103371580 | ||||||||
| FaxNumber: | 6103372133 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MALL BLVD | ||||||||
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| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194062902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103371580 | ||||||||
| FaxNumber: | 6103372133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | YESENIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7327500400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.