Provider Demographics
NPI:1104855196
Name:JORMAT OPTOMETRIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:JORMAT OPTOMETRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARLINER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-304-4724
Mailing Address - Street 1:7516 CITY AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2102
Mailing Address - Country:US
Mailing Address - Phone:215-878-7181
Mailing Address - Fax:215-878-7057
Practice Address - Street 1:7516 CITY AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2102
Practice Address - Country:US
Practice Address - Phone:215-878-7181
Practice Address - Fax:215-878-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJO1646781OtherOPTICHOICE
PAJO1646738OtherOPTICHOICE
PAJO1646738OtherOPTICHOICE
NJJO1646781OtherOPTICHOICE
PA1162470003Medicare NSC