Provider Demographics
NPI:1811038730
Name:SALA, ANTHONY D II (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:SALA
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 12TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1750
Mailing Address - Country:US
Mailing Address - Phone:814-452-2796
Mailing Address - Fax:814-454-7484
Practice Address - Street 1:128 W 12TH ST
Practice Address - Street 2:STE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1750
Practice Address - Country:US
Practice Address - Phone:814-452-2796
Practice Address - Fax:814-454-7484
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007854L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA706126OtherAETNA
PA1500653OtherGATEWAY
PA144261OtherHIGHMARK
PA49971OtherDAVIS VISION
PA000000063658OtherTHREE RIVERS
PA0015716120001Medicaid
PA156604OtherHEALTHAMERICA
PA144261E67Medicare ID - Type Unspecified
PA0015716120001Medicaid