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
Phone: (610) 825-8210
Fax: (610) 825-8208
Website:
Health care specialties
| Specialty | Code | License # | 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 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508861311 | NPPES |
| Pennsylvania | MEDICAID | 0009138590001 | |
| Pennsylvania | MEDICAID | 2205203 |
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