Provider Demographics
NPI:1629067145
Name:LEBOW, ELLEN NORD (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:NORD
Last Name:LEBOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 S AIKEN AVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1521
Mailing Address - Country:US
Mailing Address - Phone:412-621-5822
Mailing Address - Fax:412-621-3974
Practice Address - Street 1:532 S AIKEN AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1521
Practice Address - Country:US
Practice Address - Phone:412-621-5822
Practice Address - Fax:412-621-3974
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006128P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009203640001Medicaid
PAT30618Medicare UPIN
PA1009203640001Medicaid