Provider Demographics
NPI:1427098375
Name:FILIPPO, JAMES R (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:FILIPPO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3415
Mailing Address - Country:US
Mailing Address - Phone:215-335-9090
Mailing Address - Fax:215-333-5225
Practice Address - Street 1:2614 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3415
Practice Address - Country:US
Practice Address - Phone:215-335-9090
Practice Address - Fax:215-333-5225
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGOO1388152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU06321Medicare UPIN
PAFI287196Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA0266930001Medicare NSC