Provider Demographics
NPI:1598008526
Name:EYETIQUE CORP
Entity Type:Organization
Organization Name:EYETIQUE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-422-5300
Mailing Address - Street 1:2242 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2308
Mailing Address - Country:US
Mailing Address - Phone:412-422-5300
Mailing Address - Fax:
Practice Address - Street 1:3001 WATERDAM PLAZA DR
Practice Address - Street 2:SUITE 120, ROUTE19
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5415
Practice Address - Country:US
Practice Address - Phone:724-260-0243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty