Provider Demographics
NPI:1376982355
Name:CHIRUMBOLO, ANTONIO (OD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CHIRUMBOLO
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 1:2414 SILVER OAK DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3933
Mailing Address - Country:US
Mailing Address - Phone:412-726-3960
Mailing Address - Fax:
Practice Address - Street 1:2414 SILVER OAK DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3933
Practice Address - Country:US
Practice Address - Phone:412-726-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist