Provider Demographics
NPI:1376649855
Name:SPIVAK, PAUL MELVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MELVIN
Last Name:SPIVAK
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 1:2893 W LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2619
Mailing Address - Country:US
Mailing Address - Phone:412-344-8691
Mailing Address - Fax:412-344-6962
Practice Address - Street 1:2893 W LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2619
Practice Address - Country:US
Practice Address - Phone:412-344-8691
Practice Address - Fax:412-344-6962
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0704240001Medicare NSC
PAU07991Medicare UPIN