Provider Demographics
NPI:1386784072
Name:CENTRAL BUCKS OPHTHALMOLOGY, LLC
Entity type:Organization
Organization Name:CENTRAL BUCKS OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LONGSHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-348-4554
Mailing Address - Street 1:410 FARM LN
Mailing Address - Street 2:THE CARRAIGE HOUSE
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4740
Mailing Address - Country:US
Mailing Address - Phone:215-348-4554
Mailing Address - Fax:215-348-4968
Practice Address - Street 1:410 FARM LN
Practice Address - Street 2:THE CARRAIGE HOUSE
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4740
Practice Address - Country:US
Practice Address - Phone:215-348-4554
Practice Address - Fax:215-348-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063813L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7638537OtherAETNA NON-HMO GROUP NUMBE
PAP3275675OtherOXFORD
PA3476993OtherAETNA HMO GROUP NUMBER
PA1595442OtherBLUE SHIELD GROUP NUMBER
PA=========OtherUNITED
PA=========OtherCIGNA
PACE079016Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER