Provider Demographics
NPI:1376677179
Name:EYES ON REGENT SQUARE
Entity Type:Organization
Organization Name:EYES ON REGENT SQUARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:WELDON
Authorized Official - Last Name:KAMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-731-2020
Mailing Address - Street 1:1201 S BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1275
Mailing Address - Country:US
Mailing Address - Phone:412-731-2020
Mailing Address - Fax:
Practice Address - Street 1:1201 S BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1275
Practice Address - Country:US
Practice Address - Phone:412-731-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01728499Medicaid
PA4500600001Medicare NSC
PA057042Medicare PIN
PADD0774Medicare PIN