Provider Demographics
NPI:1902907371
Name:DELAWARE VALLEY VISION ASSOCIATES GROUP PRACTICE, LLC
Entity Type:Organization
Organization Name:DELAWARE VALLEY VISION ASSOCIATES GROUP PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-750-0400
Mailing Address - Street 1:1018 W 9TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1225
Mailing Address - Country:US
Mailing Address - Phone:610-337-1580
Mailing Address - Fax:610-337-2133
Practice Address - Street 1:200 MALL BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2902
Practice Address - Country:US
Practice Address - Phone:610-337-1580
Practice Address - Fax:610-337-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
095477Medicare ID - Type Unspecified