Provider Demographics
NPI:1104848597
Name:ALLEGHENY VISION ASSOCIATES
Entity Type:Organization
Organization Name:ALLEGHENY VISION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-854-4130
Mailing Address - Street 1:6305 LIBRARY RD
Mailing Address - Street 2:P.O. BOX 423
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-8502
Mailing Address - Country:US
Mailing Address - Phone:412-854-4130
Mailing Address - Fax:412-854-8175
Practice Address - Street 1:6305 LIBRARY ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH PARK
Practice Address - State:PA
Practice Address - Zip Code:15129-8308
Practice Address - Country:US
Practice Address - Phone:412-854-4130
Practice Address - Fax:412-854-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172515602Medicaid
PA410039330OtherMEDICARE RAILROAD
PA172515602Medicaid
PA0454200001Medicare NSC
PAT-98301Medicare UPIN