Basic Information
| Provider Information | |||||||||
| NPI: | 1932165594 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHESTER COUNTY OPTICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 841 E BALTIMORE PIKE | ||||||||
| Address2: | SHOPPES AT LONGWOOD | ||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193481801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104445252 | ||||||||
| FaxNumber: | 6104444211 | ||||||||
| Practice Location | |||||||||
| Address1: | 841 E BALTIMORE PIKE | ||||||||
| Address2: | SHOPPES AT LONGWOOD | ||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193481801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104445252 | ||||||||
| FaxNumber: | 6104444211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 09/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | STRATTON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6106925019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | KS5252 | 01 | PA | DAVIS | OTHER | CH285519 | 01 | PA | BLUE SHIELD HIGHMARK | OTHER | OP0462 | 01 | PA | EYEMED | OTHER |