Provider Demographics
NPI:1003814559
Name:BALITSKI, THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BALITSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LOCUST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3397
Mailing Address - Country:US
Mailing Address - Phone:724-228-1028
Mailing Address - Fax:888-506-6237
Practice Address - Street 1:400 LOCUST AVE STE 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3397
Practice Address - Country:US
Practice Address - Phone:724-228-1028
Practice Address - Fax:888-506-6237
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000676152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA255641OtherHEALTHAMERICA IND. #
PA0001266939001Medicaid
PA1317065OtherHIGHMARK GRP. #
PA234607OtherHEALTHAMERICA GRP. #
PABA701466OtherHIGHMARK IND. #
PA314110OtherUPMC
PA255641OtherHEALTHAMERICA IND. #
PA314110OtherUPMC