Provider Demographics
NPI:1114088820
Name:TERRAVECCHIA, JOSEPH ANDREW (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDREW
Last Name:TERRAVECCHIA
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 1:1750 NEW BUTLER RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3184
Mailing Address - Country:US
Mailing Address - Phone:724-654-2641
Mailing Address - Fax:724-654-1558
Practice Address - Street 1:1750 NEW BUTLER RD STE A
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3184
Practice Address - Country:US
Practice Address - Phone:724-654-2641
Practice Address - Fax:724-654-1558
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU90513Medicare UPIN
PA058440Medicare PIN