Provider Demographics
NPI:1255314043
Name:MASTRIAN, LOUIS W (OD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:W
Last Name:MASTRIAN
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 1:490 N KERRWOOD DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5202
Mailing Address - Country:US
Mailing Address - Phone:724-342-2733
Mailing Address - Fax:724-342-6652
Practice Address - Street 1:490 N KERRWOOD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5202
Practice Address - Country:US
Practice Address - Phone:724-342-2733
Practice Address - Fax:724-342-6652
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001214412Medicaid
OH418468Medicaid
OH418468Medicaid
PA629692RN0Medicare PIN