1477739274 NPI number — MGM OPTICS, INC

Table of content: (NPI 1477739274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477739274 NPI number — MGM OPTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MGM OPTICS, 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:
1477739274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 PENN CENTER BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15235-5435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-824-1755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 PENN CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-824-1755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOMICH
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-824-1755

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 393866 . This is a "NATIONAL VISION BENEFITS OF AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000292384 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 49668 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1619967429 . This is a "OPTICARE MANAGED VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA00201 . This is a "VISION BENEFITS OF AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP2144 . This is a "EYEMED VISION CARE" identifier . This identifiers is of the category "OTHER".