Provider Demographics
NPI:1619967429
Name:MOMICH, MATTHEW (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MOMICH
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PENN CENTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5435
Mailing Address - Country:US
Mailing Address - Phone:412-824-1755
Mailing Address - Fax:412-824-1821
Practice Address - Street 1:201 PENN CENTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5435
Practice Address - Country:US
Practice Address - Phone:412-824-1755
Practice Address - Fax:412-824-1821
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1237470001Medicare NSC