Provider Demographics
NPI:1699280719
Name:PEDIATRIC OPHTHALMOLOGY & STRABISMUS ASSOCIATES OF SOUTHEASTERN PA
Entity type:Organization
Organization Name:PEDIATRIC OPHTHALMOLOGY & STRABISMUS ASSOCIATES OF SOUTHEASTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-292-1698
Mailing Address - Street 1:215 HIGHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2634
Mailing Address - Country:US
Mailing Address - Phone:856-470-4776
Mailing Address - Fax:866-607-4450
Practice Address - Street 1:3855 W CHESTER PIKE STE 335
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:610-347-7672
Practice Address - Fax:610-347-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426706207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014748450002Medicaid