Provider Demographics
NPI:1487640348
Name:ROSCIA, MATTHEW A (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:ROSCIA
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 1:600 E. PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5530
Mailing Address - Country:US
Mailing Address - Phone:814-946-0821
Mailing Address - Fax:814-941-2520
Practice Address - Street 1:600 E. PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5530
Practice Address - Country:US
Practice Address - Phone:814-946-0821
Practice Address - Fax:814-941-2520
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 001468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022056540002Medicaid
PA1653322OtherHIGHMARK BLUE CROSS/BLUE SHIELD
PA086735Medicare ID - Type Unspecified
PA1022056540002Medicaid