Provider Demographics
NPI:1821404393
Name:JILL D CUTHBERTSON, OD, PC
Entity Type:Organization
Organization Name:JILL D CUTHBERTSON, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTHBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-459-5128
Mailing Address - Street 1:1344 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2462
Mailing Address - Country:US
Mailing Address - Phone:814-868-0895
Mailing Address - Fax:814-868-0896
Practice Address - Street 1:1344 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2462
Practice Address - Country:US
Practice Address - Phone:814-868-0895
Practice Address - Fax:814-868-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001531332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019618410001Medicaid
PA0019618410001Medicaid