Provider Demographics
NPI:1033100805
Name:GOOD LOOKS EYEWEAR INC
Entity Type:Organization
Organization Name:GOOD LOOKS EYEWEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-772-5420
Mailing Address - Street 1:105 BRANDT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6437
Mailing Address - Country:US
Mailing Address - Phone:724-772-5474
Mailing Address - Fax:724-772-5423
Practice Address - Street 1:20215 ROUTE 19
Practice Address - Street 2:SUITE 104
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6146
Practice Address - Country:US
Practice Address - Phone:724-772-9090
Practice Address - Fax:724-772-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037014E332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001738360007Medicaid
PAGL000256582OtherBLUESHIELD
PAGL000256582OtherBLUESHIELD