Organization
DREXEL UNIVERSITY
Active
Other names
The Eye Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD E WALDOV (DIRECTOR OF REVENUE CYCLE)
(215) 255-7751
Entity
Organization
Contact information
Practice address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Mailing address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005591590030
—
PA
01
—
0053189000
KEYSTONE EAST OPHTHALMOLO
PA
01
—
0062163000
KEYSTONE EAST OPTOMETRIC
PA
01
—
01628
HEALTH PARTNERS PA
PA
01
—
026958
PA BLUE SHIELD OPTOMETRIC
PA
01
—
1002136
MERCY HEALTH PLAN PA
PA
01
—
132200
PA BLUE SHIELD OPHTHALMOL
PA
01
—
2248
AETNA US HEALTHCARE
PA
Enumeration date
07/21/2006
Last updated
04/04/2025
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