Provider Demographics
NPI:1427030626
Name:TASSARI, DEBORAH ANN
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:TASSARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 OAKLAND AVE
Mailing Address - Street 2:PETER'S OPTICAL SHOPPE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3503
Mailing Address - Country:US
Mailing Address - Phone:412-681-8913
Mailing Address - Fax:412-681-1436
Practice Address - Street 1:124 OAKLAND AVE
Practice Address - Street 2:PETER'S OPTICAL SHOPPE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3503
Practice Address - Country:US
Practice Address - Phone:412-681-8913
Practice Address - Fax:412-681-1436
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010702980002Medicaid
PA332B00000XMedicaid
PA0010702980002Medicaid