Provider Demographics
NPI:1861054322
Name:KING OF PRUSSIA FAMILY EYE CARE P.C.
Entity type:Organization
Organization Name:KING OF PRUSSIA FAMILY EYE CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-265-0765
Mailing Address - Street 1:860 FIRST AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-265-0765
Mailing Address - Fax:610-265-6824
Practice Address - Street 1:860 FIRST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-265-0765
Practice Address - Fax:610-265-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty