Provider Demographics
NPI:1093438517
Name:MAIN LINE FAMILY EYE CARE
Entity type:Organization
Organization Name:MAIN LINE FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:URIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:551-206-3795
Mailing Address - Street 1:18 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3151
Mailing Address - Country:US
Mailing Address - Phone:215-745-0993
Mailing Address - Fax:
Practice Address - Street 1:139 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2821
Practice Address - Country:US
Practice Address - Phone:610-973-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030535100002Medicaid