Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG 000635 | PA |
NPI | 1003854613 |
---|---|
Provider Name | Vivian Descant |
First Address | Southampton, PA 18966-4005 |
Second Address | Southampton, PA 18966-4005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 14/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0465652000 | AMERIHEALTH (01) | PA |
0465652000 | KEYSTONE (01) | PW |
0465652000 | PERSONAL CHOICE (01) | PA |
2144007 | AETNA (01) | PA |
DE106053 | BLUE CROSS AND SHIELD (01) | PA |
DE1700448 | BLUE CROSS AND SHIELD (01) | PA |
U67250 | (02) | PA |
X002692560 | AMERICHOICE (01) | PA |