Provider Demographics
NPI:1992784821
Name:EYE SURGERY CENTER OF CHESTER COUNTY, LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF CHESTER COUNTY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTING ADMIN. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:KITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-280-9144
Mailing Address - Street 1:140 JOHN ROBERT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2656
Mailing Address - Country:US
Mailing Address - Phone:610-280-9144
Mailing Address - Fax:610-280-0797
Practice Address - Street 1:140 JOHN ROBERT THOMAS DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2656
Practice Address - Country:US
Practice Address - Phone:610-280-9144
Practice Address - Fax:610-280-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11081500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0075577000002Medicaid
034270Medicare ID - Type UnspecifiedMEDICARE ID #