Provider Demographics
NPI:1851430490
Name:LIGONIER EYE ASSOCIATES
Entity Type:Organization
Organization Name:LIGONIER EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-539-1671
Mailing Address - Street 1:1010 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1882
Mailing Address - Country:US
Mailing Address - Phone:724-539-1671
Mailing Address - Fax:724-539-1654
Practice Address - Street 1:1010 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1882
Practice Address - Country:US
Practice Address - Phone:724-539-1671
Practice Address - Fax:724-539-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA634740Medicare PIN