Provider Demographics
NPI:1821078924
Name:SAMES, THEODORE R JR (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:R
Last Name:SAMES
Suffix:JR
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 1:238 CRESSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037
Mailing Address - Country:US
Mailing Address - Phone:412-751-6600
Mailing Address - Fax:412-751-6485
Practice Address - Street 1:238 CRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037
Practice Address - Country:US
Practice Address - Phone:412-751-6600
Practice Address - Fax:412-751-6485
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011379400002Medicaid
PA206767OtherUPMC
PA251591408OtherUNITED HEALTHCARE
PA6363107OtherCIGNA
PA532373OtherHIGHMARK
PAT98260OtherHEALTHAMERICA
PA452689OtherAETNA
PA6363107OtherCIGNA
PA0132770001Medicare NSC
PA251591408OtherUNITED HEALTHCARE