Individual
GARY ITZENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
413 GERMANTOWN PIKE, STE 200, LAFAYETTE HILL, PA 19444-1816
(610) 825-8210
(610) 825-8208
Mailing address
413 GERMANTOWN PIKE STE 200, LAFAYETTE HILL, PA 19444-1816
(610) 825-8210
(610) 825-8208
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
27OA00437400
NJ
152W00000X
Optometrist
Primary
OE006115T
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009138590001
—
PA
05
—
2205203
—
NJ
Enumeration date
06/17/2005
Last updated
02/06/2026
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