1578233490 NPI number — LAPPEN EYE CARE- SOUTH HILLS INC

Table of content: MRS. JACQUELYN POULIN LCPC, ATR (NPI 1720471378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578233490 NPI number — LAPPEN EYE CARE- SOUTH HILLS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAPPEN EYE CARE- SOUTH HILLS INC
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:
1578233490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-5518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-837-5350
Provider Business Mailing Address Fax Number:
724-837-5352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2639 BROWNSVILLE RD
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:
15227-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-5350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LAPPEN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-837-5350

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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