Organization
KINGSTON OPHTHALMOLOGY ASC LLC
Active
Other names
Kingston Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP A. CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
601 WYOMING AVE, KINGSTON, PA 18704-3701
(570) 288-7405
(570) 714-0419
Mailing address
601 WYOMING AVE, KINGSTON, PA 18704-3701
(570) 288-7405
(570) 714-0419
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1640867
BLUE SHIELD
PA
01
—
DB1516
RAILROAD MEDICARE
PA
Enumeration date
04/16/2008
Last updated
09/07/2023
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