Basic Information
Provider Information | |||||||||
NPI: | 1982734547 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HALPERN EYE ASSOCIATES P. A. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HALPERN EYE CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 885 S GOVERNORS AVE | ||||||||
Address2: |   | ||||||||
City: | DOVER | ||||||||
State: | DE | ||||||||
PostalCode: | 199044158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3027345861 | ||||||||
FaxNumber: | 3027341921 | ||||||||
Practice Location | |||||||||
Address1: | 1197 AIRPORT RD | ||||||||
Address2: |   | ||||||||
City: | MILFORD | ||||||||
State: | DE | ||||||||
PostalCode: | 199636418 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3024222020 | ||||||||
FaxNumber: | 3024224507 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/06/2007 | ||||||||
LastUpdateDate: | 04/14/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HALPERN | ||||||||
AuthorizedOfficialFirstName: | SAMUEL | ||||||||
AuthorizedOfficialMiddleName: | RYAN | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT/OPTOMETRIST | ||||||||
AuthorizedOfficialTelephone: | 3027345861 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | O. D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | 0000950845 | 05 | DE |   | MEDICAID | 1982734547 | 01 | DE | LOCATION NPI | OTHER |