1902815053 NPI number — VISIONMAKERS OF PA

Table of content: DR. SERGIO CRUZ CASACLANG MD (NPI 1871502906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902815053 NPI number — VISIONMAKERS OF PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONMAKERS OF PA
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:
6
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:
1902815053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1934 PARK MANOR BLVD
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:
15205-4809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-788-4664
Provider Business Mailing Address Fax Number:
412-788-6003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1934 PARK MANOR BLVD
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:
15205-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-788-4664
Provider Business Practice Location Address Fax Number:
412-788-6003
Provider Enumeration Date:
08/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STAHL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
937-258-1515

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)