Provider Demographics
NPI:1477739274
Name:MGM OPTICS, INC
Entity Type:Organization
Organization Name:MGM OPTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOMICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-824-1755
Mailing Address - Street 1:201 PENN CENTER BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5435
Mailing Address - Country:US
Mailing Address - Phone:412-824-1755
Mailing Address - Fax:
Practice Address - Street 1:201 PENN CENTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5435
Practice Address - Country:US
Practice Address - Phone:412-824-1755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
393866OtherNATIONAL VISION BENEFITS OF AMERICA
000292384OtherHIGHMARK BLUE CROSS BLUE SHIELD
49668OtherDAVIS VISION
1619967429OtherOPTICARE MANAGED VISION
PA00201OtherVISION BENEFITS OF AMERICA
OP2144OtherEYEMED VISION CARE
49668OtherDAVIS VISION