Provider Demographics
NPI:1710965264
Name:SERIA, LEROY F (OD)
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:F
Last Name:SERIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 LEECHBURG RD
Mailing Address - Street 2:STE 1
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068
Mailing Address - Country:US
Mailing Address - Phone:724-335-9151
Mailing Address - Fax:724-339-8571
Practice Address - Street 1:3275 LEECHBURG RD
Practice Address - Street 2:STE 1
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068
Practice Address - Country:US
Practice Address - Phone:724-335-9151
Practice Address - Fax:724-339-8571
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103815Medicaid
PA082012Medicare PIN
PA0769080001Medicare NSC
PAT28281Medicare UPIN