Provider Demographics
NPI:1003988296
Name:TELEGA, ALICIA NICHOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:NICHOLE
Last Name:TELEGA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1741
Mailing Address - Country:US
Mailing Address - Phone:412-404-2626
Mailing Address - Fax:412-404-2446
Practice Address - Street 1:5730 ELLSWORTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1741
Practice Address - Country:US
Practice Address - Phone:412-404-2626
Practice Address - Fax:412-404-2446
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001621152W00000X
PAOEG001865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V12109Medicare UPIN