Provider Demographics
NPI:1689491110
Name:MCDERMITH, EMILY (OD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCDERMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 JFK BLVD APT 1005
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1507
Mailing Address - Country:US
Mailing Address - Phone:207-890-4618
Mailing Address - Fax:
Practice Address - Street 1:2000 HAMILTON ST STE 306
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3847
Practice Address - Country:US
Practice Address - Phone:215-545-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist