Provider Demographics
NPI:1063520492
Name:I DO EYES II, INC.
Entity type:Organization
Organization Name:I DO EYES II, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-355-1300
Mailing Address - Street 1:225 BUSTLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6448
Mailing Address - Country:US
Mailing Address - Phone:215-355-1300
Mailing Address - Fax:215-355-8745
Practice Address - Street 1:225 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6448
Practice Address - Country:US
Practice Address - Phone:215-355-1300
Practice Address - Fax:215-355-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1656123OtherHIGHMARK BLUE SHIELD
PA086778Medicare ID - Type Unspecified