Provider Demographics
NPI:1235366386
Name:EYE CARE ASSOCIATES WEST
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES WEST
Other - Org Name:LJ COLAROSSI & KJ KOZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-262-2010
Mailing Address - Street 1:963 BEAVER GRADE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2717
Mailing Address - Country:US
Mailing Address - Phone:412-262-2010
Mailing Address - Fax:412-262-2070
Practice Address - Street 1:963 BEAVER GRADE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2717
Practice Address - Country:US
Practice Address - Phone:412-262-2010
Practice Address - Fax:412-262-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009017152W00000X
PAOEG001208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty