Organization
BROOKHAVEN FAMILY EYE CARE CENTER
Active
Other names
BROOKHAVEN VISION SOURCE
Organization subpart
No
Provider details
NPI number
Authorized official
MICAELA L SMALL OD (PRESIDENT)
(610) 872-8989
Entity
Organization
Contact information
Practice address
4106 EDGMONT AVE, BROOKHAVEN, PA 19015-2314
(610) 872-8989
(610) 872-5220
Mailing address
4106 EDGMONT AVE, BROOKHAVEN, PA 19015-2314
(610) 872-8989
(610) 872-5220
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001547
PA
332H00000X
Eyewear Supplier
OEG001547
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001429488
HIGHMARK
PA
01
—
2115330000
INDEPENDENCE BLUE CROSS
PA
01
—
2628516
AETNA GROUP HMO
PA
01
—
5498366
AETNA UNIVERSAL GROUP
PA
01
—
CM9120
RAILROAD MEDICARE
PA
Enumeration date
08/05/2006
Last updated
05/14/2024
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