1508935016 NPI number — MCBRIAR OPTOMETRY, LLC

Table of content: (NPI 1508935016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508935016 NPI number — MCBRIAR OPTOMETRY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCBRIAR OPTOMETRY, LLC
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:
1508935016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 WYNWOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRWIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15642-4741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-612-8180
Provider Business Mailing Address Fax Number:
724-864-1045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 MILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-612-8180
Provider Business Practice Location Address Fax Number:
724-864-1045
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCBRIAR
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
MATHEW
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
412-612-8180

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5587,T2501 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29114 . This is a "SPECTERA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 552211 . This is a "NVA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 22022810 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 192502827001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".