Provider Demographics
NPI:1942408505
Name:BROOMALL EYE CARE, P.C.
Entity type:Organization
Organization Name:BROOMALL EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ALLODOLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-325-7688
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:LAWRENCE PARK CENTER # 25
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3512
Mailing Address - Country:US
Mailing Address - Phone:610-325-7688
Mailing Address - Fax:610-325-7622
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:LAWRENCE PARK CENTER # 25
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3512
Practice Address - Country:US
Practice Address - Phone:610-325-7688
Practice Address - Fax:610-325-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 001600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099818 U8SMedicare ID - Type Unspecified