Provider Demographics
NPI:1275733891
Name:VISION ASSOCIATES OF WESTERN PA
Entity Type:Organization
Organization Name:VISION ASSOCIATES OF WESTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-864-4858
Mailing Address - Street 1:200 MILLCREEK PLZ
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16565-1102
Mailing Address - Country:US
Mailing Address - Phone:814-864-4858
Mailing Address - Fax:814-864-0398
Practice Address - Street 1:200 MILLCREEK PLZ
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16565-1102
Practice Address - Country:US
Practice Address - Phone:814-864-4858
Practice Address - Fax:814-864-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1521630OtherBLUE CROSS BLUE SHIELD
VI1521630OtherBLUE CROSS BLUE SHIELD