Chauncey Eye Group LLC
Organization Active NPI Optometrist · Glenolden, PA
NPI 1891292959 · NPPES record last updated Apr 6, 2018
Key facts
- NPI
- 1891292959
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OEG003215 (PA)
- Legal business name
- CHAUNCEY EYE GROUP LLC
- Practice address
- 30 South Macdade Blvd
Glenolden, PA 19036-1725 - Phone
- (610) 586-0651
- Fax
- (610) 586-0652
- NPI assigned
- Apr 6, 2018
- Organization subpart
- No
Authorized official
- Name
- Chauncey Brown Jr., OD
- Title
- OD/Owner
- Phone
- (610) 586-0651
Practitioners 1
-
Chauncey Brown Jr., D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180424002815 | PA | Part B Supplier - Clinic/Group Practice | 0244593317 |
Receives reassigned benefits from 1 practitioner Practice locations: Glenolden, PA |
National Provider Directory
Locations
30 S Macdade Blvd
Glenolden, PA 19036
Phone (610) 586-0651
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OEG003215 | PA | Yes |
Addresses
Primary practice location
30 South Macdade Blvd
Glenolden, PA 19036-1725
Mailing address
30 S Macdade Blvd
Glenolden, PA 19036-1725
Phone (610) 586-0651
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All providers in Glenolden, PA · Optometrist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.