Individual
DR. JAMIE A ELLSWORTH-NEIMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTOMETRIST
Contact information
Practice address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Mailing address
50 FIELDSTONE RD, LEVITTOWN, PA 19056-1917
(215) 945-2625
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
OEG000343
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1632843
BLUE SHIELD
PA
01
—
2248
AETNA HMO
PA
01
—
2308338000
KEYSTONE EAST
PA
Enumeration date
08/12/2006
Last updated
07/08/2007
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