Provider Demographics
NPI:1780640177
Name:CERVONE, JAMES
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:CERVONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA QUALITY
Other - Middle Name:
Other - Last Name:EYEWEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:575 LINCOLN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3550
Mailing Address - Country:US
Mailing Address - Phone:412-766-8875
Mailing Address - Fax:412-766-5760
Practice Address - Street 1:575 LINCOLN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3550
Practice Address - Country:US
Practice Address - Phone:412-766-8875
Practice Address - Fax:412-766-5760
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017377920001Medicaid
PA1221500001Medicare NSC