Provider Demographics
NPI:1194893925
Name:DELAWARE EYE ASSOCIATES PA
Entity type:Organization
Organization Name:DELAWARE EYE ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PSALTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-777-4794
Mailing Address - Street 1:TROLLEY SQUARE
Mailing Address - Street 2:UNIT 19A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806
Mailing Address - Country:US
Mailing Address - Phone:302-777-4794
Mailing Address - Fax:302-777-4872
Practice Address - Street 1:3801 KENNETT PIKE STE A102
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2307
Practice Address - Country:US
Practice Address - Phone:302-777-4794
Practice Address - Fax:302-777-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01011Medicare ID - Type Unspecified
U48794Medicare UPIN