Provider Demographics
NPI:1134653322
Name:OPHTHALMIC ASSOCIATES
Entity Type:Organization
Organization Name:OPHTHALMIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHALMOLOGISTS /PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-536-5343
Mailing Address - Street 1:120 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1578
Mailing Address - Country:US
Mailing Address - Phone:814-536-5343
Mailing Address - Fax:814-536-1525
Practice Address - Street 1:421 PARK PLACE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1718
Practice Address - Country:US
Practice Address - Phone:814-467-4551
Practice Address - Fax:814-467-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
PA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty