Organization
PHILADELPHIA EYECARE PROFESSIONALS, LLC
Active
Other names
Philadelphia Eyecare Professionals, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA BURAKS O.D. (OWNER)
(215) 530-3112
Entity
Organization
Contact information
Practice address
1601 S COLUMBUS BLVD, VISION CENTER INSIDE WALMART, PHILADELPHIA, PA 19148-1400
(215) 389-5814
(215) 755-6561
Mailing address
10 WEATHERWOOD LN, RADNOR, PA 19087-2724
(215) 530-3112
(215) 755-6561
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000739
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015391140003
—
PA
Enumeration date
12/13/2010
Last updated
04/11/2011
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