1922090323 NPI number — DR. PAUL FRED IVES OD

Table of content: DR. PAUL FRED IVES OD (NPI 1922090323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922090323 NPI number — DR. PAUL FRED IVES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVES
Provider First Name:
PAUL
Provider Middle Name:
FRED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1922090323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 N WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST NEWTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15089-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-872-5621
Provider Business Mailing Address Fax Number:
724-872-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 N WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST NEWTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15089-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-872-5621
Provider Business Practice Location Address Fax Number:
724-872-6660
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001122 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001617760 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1036189 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00155884 . This is a "PALMETTO GBA RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016651 . This is a "DORAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3501749 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 35419 . This is a "HLTH ASSURANCE/HLTH AMER." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396038 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5620390 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA96116 . This is a "VISION BENEFITS OF AMER." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 35415 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 542145620 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5463570001 . This is a "DME REGIONAL CARRIER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 201215 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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