Provider Demographics
NPI:1659435972
Name:FAMILY VISION CARE EAST
Entity Type:Organization
Organization Name:FAMILY VISION CARE EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-441-6685
Mailing Address - Street 1:5917 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3818
Mailing Address - Country:US
Mailing Address - Phone:412-441-6685
Mailing Address - Fax:
Practice Address - Street 1:5917 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3818
Practice Address - Country:US
Practice Address - Phone:412-441-6685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 001100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012700740006Medicaid
PAU20422Medicare UPIN
PA0012700740006Medicaid