Provider Demographics
NPI:1871608596
Name:IRVING I CRIDEN & SCOTT PAGE OD PC
Entity type:Organization
Organization Name:IRVING I CRIDEN & SCOTT PAGE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-627-4448
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 417
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-627-4448
Mailing Address - Fax:215-627-5798
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 417
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-627-4448
Practice Address - Fax:215-627-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225968000OtherBCBS
PA225968000OtherBCBS
PA095007Medicare ID - Type Unspecified
PA128112Medicare PIN
PA0736650001Medicare NSC