Provider Demographics
NPI:1144580994
Name:YOUR CHOICE OPTICAL, INC.
Entity Type:Organization
Organization Name:YOUR CHOICE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-984-5816
Mailing Address - Street 1:1359 CONNELLSVILLE RD
Mailing Address - Street 2:STE 18
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-1076
Mailing Address - Country:US
Mailing Address - Phone:724-438-5120
Mailing Address - Fax:
Practice Address - Street 1:1359 CONNELLSVILLE RD
Practice Address - Street 2:STE 18
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-1076
Practice Address - Country:US
Practice Address - Phone:724-438-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025274890002Medicaid
PA196507Medicare PIN