Provider Demographics
NPI:1447312848
Name:BOAS VISION ASSOCIATES LLC
Entity type:Organization
Organization Name:BOAS VISION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-363-2303
Mailing Address - Street 1:577 W UWCHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1563
Mailing Address - Country:US
Mailing Address - Phone:610-363-2303
Mailing Address - Fax:
Practice Address - Street 1:577 W UWCHLAN AVE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2639875000OtherIBX KEYSTONE HMO
PA2184691OtherAETNAHMO
PA001802523OtherHIGHMARK BLUESHIELD ID
PA2184691OtherAETNAHMO