Provider Demographics
NPI:1386718732
Name:PHILADELPHIA EYE ASSOCIATES
Entity type:Organization
Organization Name:PHILADELPHIA EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-423-5154
Mailing Address - Street 1:2610 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-5104
Mailing Address - Country:US
Mailing Address - Phone:215-423-5154
Mailing Address - Fax:215-423-4682
Practice Address - Street 1:2610 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5104
Practice Address - Country:US
Practice Address - Phone:215-423-5154
Practice Address - Fax:215-423-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
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
PA0244050002Medicare NSC