Individual
MRS. IRENE FOTIADIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
10752 BUSTLETON AVE, PHILADELPHIA, PA 19116-3367
(215) 698-7450
Mailing address
10752 BUSTLETON AVE, PHILADELPHIA, PA 19116-3367
(215) 698-7450
(215) 698-7451
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
274722379
PA
Other
Enumeration date
04/02/2007
Last updated
01/19/2012
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