Provider Demographics
NPI:1790835239
Name:MEDICAL OPTICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:MEDICAL OPTICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUMWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-741-4610
Mailing Address - Street 1:400 BROAD ST
Mailing Address - Street 2:SUTIE 2020
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1500
Mailing Address - Country:US
Mailing Address - Phone:412-741-4610
Mailing Address - Fax:412-741-8967
Practice Address - Street 1:400 BROAD ST
Practice Address - Street 2:SUTIE 2020
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1500
Practice Address - Country:US
Practice Address - Phone:412-741-4610
Practice Address - Fax:412-741-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007737020001Medicaid
PA0378430001Medicare ID - Type Unspecified