Provider Demographics
NPI:1508309600
Name:WEST PENN EYE ASSOCIATES
Entity Type:Organization
Organization Name:WEST PENN EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-621-7038
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE M-25
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-621-7038
Mailing Address - Fax:412-578-1166
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE M-25
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-621-7038
Practice Address - Fax:412-578-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047489L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011635570004Medicaid
PA0011635570004Medicaid
PA417056Medicare PIN