Provider Demographics
NPI:1326233206
Name:PAVILION OPTICAL
Entity Type:Organization
Organization Name:PAVILION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:412-621-7098
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:M-25
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-621-7038
Mailing Address - Fax:412-578-1166
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:M-25
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-621-7038
Practice Address - Fax:412-578-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0249020001Medicare NSC