Premiervision Laser Center, Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD069007L Issued in PA

Legal business name

PREMIERVISION LASER CENTER, INC.

Doing business as

Cordelia N. Uddoh, MD

Practice address

3212 W Cheltenham Ave
Philadelphia, PA 19150-1003

Phone

(215) 657-5044

Fax

(215) 657-5046

NPI assigned

Dec 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Cordelia Nkolika Uddoh, MDNPI 1821179243

Title

President

Phone

(215) 657-5044

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Cordelia N. Uddoh, MD Doing business as

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: cuddoh@pvlc.intellechartdirect.net

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cordelia Nkolika Uddoh, MD

  • Ophthalmology Physician
  • Philadelphia, PA
  • NPI 1821179243
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1699833855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 539",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190900539",
            "telephone_number": "215-657-5044",
            "fax_number": "215-657-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3212 W CHELTENHAM AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191501003",
            "telephone_number": "215-657-5044",
            "fax_number": "215-657-5046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "608 Easton Rd",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Willow Grove",
            "state": "PA",
            "postal_code": "190902528",
            "country_code": "US",
            "telephone_number": "215-657-5044",
            "fax_number": "215-657-5046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIERVISION LASER CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "UDDOH",
        "authorized_official_first_name": "CORDELIA",
        "authorized_official_middle_name": "NKOLIKA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-657-5044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD069007L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-PTAN",
            "identifier": "187975",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012162880001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cuddoh@pvlc.intellechartdirect.net",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3212 W Cheltenham Ave",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191501003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cuddoh@pvlc.intellechartdirect.net",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "608 Easton Rd",
            "address_2": "Suite C",
            "city": "Willow Grove",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190902528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cordelia N. Uddoh, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ophthalmology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Ophthalmology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.