NPIMap

Organization Active NPI

Philadelphia Eyecare Professionals, LLC

  • Optometrist
  • Philadelphia, PA
National Provider Identifier
1598068504
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000739 Issued in PA
Legal business name
PHILADELPHIA EYECARE PROFESSIONALS, LLC
Practice address
1601 S Columbus Blvd
Vision Center Inside Walmart
Philadelphia, PA 19148-1400
Phone
(215) 389-5814
Fax
(215) 755-6561
NPI assigned
Dec 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lisa Buraks, O.D.
Title
Owner
Phone
(215) 530-3112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OEG000739 PA Primary

Addresses

Primary practice location

1601 S Columbus Blvd
Vision Center Inside Walmart
Philadelphia, PA 19148-1400

Mailing address

10 Weatherwood LN
Radnor, PA 19087-2724
Phone (215) 530-3112

Other identifiers 1

IdentifierTypeStateIssuer
0015391140003MedicaidPA

Other names 1

  • Philadelphia Eyecare Professionals, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

1675 S Columbus Blvd
Philadelphia, PA 19148
Phone (215) 389-5814

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1598068504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WEATHERWOOD LN",
            "city": "RADNOR",
            "state": "PA",
            "postal_code": "190872724",
            "telephone_number": "215-530-3112",
            "fax_number": "215-755-6561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 S COLUMBUS BLVD",
            "address_2": "VISION CENTER INSIDE WALMART",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191481400",
            "telephone_number": "215-389-5814",
            "fax_number": "215-755-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA EYECARE PROFESSIONALS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "BURAKS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-530-3112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015391140003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philadelphia Eyecare Professionals, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.