Provider Demographics
NPI:1558587923
Name:DUPLAGA, CHARLES EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:DUPLAGA
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 1:2025 STERLING DRIVE
Mailing Address - Street 2:
Mailing Address - City:MCDONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057
Mailing Address - Country:US
Mailing Address - Phone:412-221-9003
Mailing Address - Fax:412-833-1809
Practice Address - Street 1:400 BROAD ST
Practice Address - Street 2:SUITE 2020
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1500
Practice Address - Country:US
Practice Address - Phone:412-741-4610
Practice Address - Fax:412-741-8967
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007008T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA910529OtherEYE MED VISION CARE
PA0018067460002Medicaid
PA50905OtherDAVIS VISION
PA50905OtherDAVIS VISION