Provider Demographics
NPI:1598915092
Name:G.M. CREVAR OPT INC
Entity Type:Organization
Organization Name:G.M. CREVAR OPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:CREVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-466-7452
Mailing Address - Street 1:3519 HOMESTEAD, DUQUESNE RD.
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122
Mailing Address - Country:US
Mailing Address - Phone:412-466-7452
Mailing Address - Fax:412-466-7452
Practice Address - Street 1:3519 HOMESTEAD, DUQUESNE RD.
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122
Practice Address - Country:US
Practice Address - Phone:412-466-7452
Practice Address - Fax:412-466-7452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0747930001Medicare NSC