Provider Demographics
NPI:1508970294
Name:COLAROSSI, LEO JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:JOSEPH
Last Name:COLAROSSI
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 1:963 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2717
Mailing Address - Country:US
Mailing Address - Phone:412-262-2010
Mailing Address - Fax:412-262-2070
Practice Address - Street 1:963 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2717
Practice Address - Country:US
Practice Address - Phone:412-262-2010
Practice Address - Fax:412-262-2070
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001208152W00000X
OH4810/1675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA690071Medicare ID - Type Unspecified
PAU47701Medicare UPIN