Provider Demographics
NPI:1821062662
Name:FATICA, FRANK A (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:FATICA
Suffix:
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:GARY T BROTHERSON MD INC NIAGARA EYE ASSOC
Mailing Address - Street 2:1801 WEST 8 TH STREET
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4938
Mailing Address - Country:US
Mailing Address - Phone:814-455-8004
Mailing Address - Fax:891-445-6605
Practice Address - Street 1:GARY T BROTHERSON MD INC NIAGARA EYE ASSOC
Practice Address - Street 2:1801 WEST 8 TH STREET
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4938
Practice Address - Country:US
Practice Address - Phone:814-455-8004
Practice Address - Fax:814-456-6054
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010267L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011674140001Medicaid
PA1011674140002Medicaid
PAOS010267LOtherLICENSE
PAH72254Medicare UPIN
PA1011674140002Medicaid
PA062849US8Medicare PIN
PA1011674140001Medicaid