Provider Demographics
NPI:1891711537
Name:BALITSKI VISION PC
Entity Type:Organization
Organization Name:BALITSKI VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BALITSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-775-2021
Mailing Address - Street 1:3468 BRODHEAD RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3149
Mailing Address - Country:US
Mailing Address - Phone:724-775-2021
Mailing Address - Fax:724-775-2025
Practice Address - Street 1:3468 BRODHEAD RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3149
Practice Address - Country:US
Practice Address - Phone:724-775-2021
Practice Address - Fax:724-775-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1266939001Medicaid
PA056453Medicare ID - Type Unspecified