Provider Demographics
NPI:1629127683
Name:PEDIATRIC OPHTHALMOLOGY OF ERIE, INC
Entity Type:Organization
Organization Name:PEDIATRIC OPHTHALMOLOGY OF ERIE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-454-6307
Mailing Address - Street 1:128 W 12TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1750
Mailing Address - Country:US
Mailing Address - Phone:814-454-6307
Mailing Address - Fax:814-454-6397
Practice Address - Street 1:128 W 12TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501
Practice Address - Country:US
Practice Address - Phone:814-454-6307
Practice Address - Fax:814-454-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty