Provider Demographics
NPI:1063423309
Name:MODERN EYE INC
Entity type:Organization
Organization Name:MODERN EYE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:ANASTASIOU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-922-3300
Mailing Address - Street 1:145 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4916
Mailing Address - Country:US
Mailing Address - Phone:215-922-3300
Mailing Address - Fax:215-922-0775
Practice Address - Street 1:145 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4916
Practice Address - Country:US
Practice Address - Phone:215-922-3300
Practice Address - Fax:215-922-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA OB008278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty