Provider Demographics
NPI:1114966090
Name:ALTOONA OPHTHALMOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ALTOONA OPHTHALMOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-946-0821
Mailing Address - Street 1:600 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5530
Mailing Address - Country:US
Mailing Address - Phone:814-946-0821
Mailing Address - Fax:814-941-2520
Practice Address - Street 1:600 E PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5530
Practice Address - Country:US
Practice Address - Phone:814-946-0821
Practice Address - Fax:814-941-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007193OtherGATEWAY
PA0014595230004Medicaid
PA637848OtherBLUE SHIELD
PA0774610001Medicare NSC
PA637848OtherBLUE SHIELD