Provider Demographics
NPI:1043264195
Name:OPHTHALMOLOGY CTR. , LTD.
Entity type:Organization
Organization Name:OPHTHALMOLOGY CTR. , LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-429-2199
Mailing Address - Street 1:1637 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1003
Mailing Address - Country:US
Mailing Address - Phone:215-465-7100
Mailing Address - Fax:215-463-3550
Practice Address - Street 1:1637 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1003
Practice Address - Country:US
Practice Address - Phone:215-465-7100
Practice Address - Fax:215-463-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ55507OtherUS HEALTHCARE
NJ0114330000OtherAMERIHEALTH
NJ55507OtherUS HEALTHCARE
NJ0114330000OtherAMERIHEALTH