1811064561 NPI number — PITTSBURGH OCULOPLASTIC ASSOCIATES, LTD

Table of content: (NPI 1811064561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811064561 NPI number — PITTSBURGH OCULOPLASTIC ASSOCIATES, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PITTSBURGH OCULOPLASTIC ASSOCIATES, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811064561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750 CENTRE AVE STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15206-3761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-681-4220
Provider Business Mailing Address Fax Number:
412-681-4396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 CENTRE AVE STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15206-3761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-681-4220
Provider Business Practice Location Address Fax Number:
412-681-4396
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUERGER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-681-4220

Provider Taxonomy Codes

  • Taxonomy code: 207WX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0701879 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810005049 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010040780001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".