Basic Information
| Provider Information | |||||||||
| NPI: | 1992815930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 OVERLOOK RD | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080772207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098292133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 W GODFREY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152766000 | ||||||||
| FaxNumber: | 2152761329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WP0200X | OEG001419 | PA | Y | Eye and Vision Services Providers | Optometrist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2235456000 | 01 | PA | KHPE | OTHER | 1552345 | 01 | PA | BLUE SHOELD | OTHER | 2248 | 01 | PA | AETNA HMO | OTHER |