Provider Demographics
NPI:1346274578
Name:SOUTH HILLS EYE ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:SOUTH HILLS EYE ASSOCIATES, LTD.
Other - Org Name:SOUTH HILLS OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NABEREZNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-561-1964
Mailing Address - Street 1:189 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1765
Mailing Address - Country:US
Mailing Address - Phone:724-745-6452
Mailing Address - Fax:724-745-8431
Practice Address - Street 1:189 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1765
Practice Address - Country:US
Practice Address - Phone:724-745-6452
Practice Address - Fax:724-745-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0334040003Medicare ID - Type Unspecified