Provider Demographics
NPI:1316426240
Name:PINE VISION CARE PC
Entity type:Organization
Organization Name:PINE VISION CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYRINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-575-5198
Mailing Address - Street 1:1018 PINE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6069
Mailing Address - Country:US
Mailing Address - Phone:215-575-5198
Mailing Address - Fax:215-982-1193
Practice Address - Street 1:1018 PINE ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6069
Practice Address - Country:US
Practice Address - Phone:215-575-5198
Practice Address - Fax:215-982-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty