Provider Demographics
NPI:1699979443
Name:COLONIAL OPTOMETRIC ASSOCIATES PC
Entity type:Organization
Organization Name:COLONIAL OPTOMETRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BUDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-269-2191
Mailing Address - Street 1:287 W UWCHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3361
Mailing Address - Country:US
Mailing Address - Phone:610-269-2191
Mailing Address - Fax:610-269-5055
Practice Address - Street 1:287 W UWCHLAN AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3361
Practice Address - Country:US
Practice Address - Phone:610-269-2191
Practice Address - Fax:610-269-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005619P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA857613Medicare PIN
PA1096140001Medicare NSC