NPIMap

Organization Active NPI

Aeg Pennsylvania Professional, Inc

  • Optometrist
  • Upper Darby, PA
National Provider Identifier
1548034275
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG PENNSYLVANIA PROFESSIONAL, INC
Practice address
1560 Garrett Rd Ste F
Upper Darby, PA 19082-4516
Phone
(610) 951-6223
NPI assigned
Nov 13, 2023
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Benjamin Chudner
Title
Owner
Phone
(314) 741-4947

Corporate family (same tax ID) 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

National Provider Directory

National Provider Directory
Tax ID family
Aeg Pennsylvania Prof Inc (29 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

1560 Garrett Rd Ste F
Upper Darby, PA 19082-4516

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818

Other names 1

NPPES NPI Registry
  • Olympus Vision Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 13, 2023.

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1548034275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 GARRETT RD STE F",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190824516",
            "telephone_number": "610-951-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG PENNSYLVANIA PROFESSIONAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "CHUDNER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-741-4947"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olympus Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upper Darby, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.