Organization
POV LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL BUMSTED O.D. (MANAGING MEMBER)
(610) 459-0404
Entity
Organization
Contact information
Practice address
736 BALTIMORE PIKE STE 8, GLEN MILLS, PA 19342-1074
(610) 459-0404
(610) 459-0405
Mailing address
736 BALTIMORE PIKE STE 8, GLEN MILLS, PA 19342-1074
(610) 459-0404
(610) 459-0405
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4585515
AETNA
PA
Enumeration date
09/09/2019
Last updated
09/09/2019
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