Organization
EYE SURGICAL MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH L THOMPSON (CREDENTIALING)
(215) 342-8118
Entity
Organization
Contact information
Practice address
8118 BUSTLETON AVE, PHILA, PA 19152-2803
(215) 342-8118
(215) 725-4999
Mailing address
8118 BUSTLETON AVE, PHILA, PA 19152
(215) 342-8118
(215) 725-4999
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OE005574
PA
207W00000X
Ophthalmology Physician
Primary
—
PA
332H00000X
Eyewear Supplier
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010888550007
—
PA
01
—
00531400000
DENNIS J KHOURY MD
PA
01
—
0053171000
KEYSTONE
PA
01
—
0053194000
M SHAYEGAN MD
PA
01
—
114458
HIGHMARK BLUE SHIELD
PA
01
—
180010359
RAILROAD MEDICARE
PA
01
—
2740362000
IBC
PA
01
—
57346
AETNA
PA
01
—
890541
HIGHMARK BLUE SHIELD
PA
01
—
CF4471
RAILROAD MEDICARE
PA
Enumeration date
06/15/2006
Last updated
01/07/2021
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