Itzenson, Gary

Itzenson, Gary is an individual health care provider with primary practice located at 413 Germantown Pike Ste 200, Lafayette Hill PA 19444-1816. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Itzenson, Gary can be contacted via phone (610) 825-8210.

Contact Information

Primary practice address
413 Germantown Pike Ste 200 Lafayette Hill PA 19444-1816
Fax: (610) 825-8208
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 27OA00437400 New Jersey
Eye and Vision Services Providers / Optometrist 152W00000X OE006115T Pennsylvania

Profile Details

NPI number 1508861311
LBN Legal business name Itzenson, Gary
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Dec 4th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508861311 NPPES
Pennsylvania MEDICAID 0009138590001
Pennsylvania MEDICAID 2205203

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