Provider Demographics
NPI:1568538833
Name:ADVANCED OCULAR PROSTHETICS INCORPORATED
Entity Type:Organization
Organization Name:ADVANCED OCULAR PROSTHETICS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:LEIMKUEHLER
Authorized Official - Last Name:KINNEER
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:412-787-7277
Mailing Address - Street 1:1111 OAKDALE RD
Mailing Address - Street 2:STE. 5
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-1523
Mailing Address - Country:US
Mailing Address - Phone:412-787-7277
Mailing Address - Fax:
Practice Address - Street 1:1111 OAKDALE RD
Practice Address - Street 2:STE. 5
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-1523
Practice Address - Country:US
Practice Address - Phone:412-787-7277
Practice Address - Fax:412-787-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
001780874OtherHIGHMARK PROVIDER NUMBER
5580260001Medicare NSC