Provider Demographics
NPI:1386680155
Name:MENDICINO, MICHAEL A (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MENDICINO
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 1:1145 BOWER HILL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1342
Mailing Address - Country:US
Mailing Address - Phone:412-572-6121
Mailing Address - Fax:412-571-1327
Practice Address - Street 1:1145 BOWER HILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1800
Practice Address - Country:US
Practice Address - Phone:412-572-6121
Practice Address - Fax:412-571-1327
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018518300002Medicaid
PA410045262OtherRAILROAD MEDICARE
PA2082328OtherHEALTH AMERICA
PA139745OtherAETNA
PA717084Medicare PIN
PA410045262OtherRAILROAD MEDICARE
PA139745OtherAETNA