Provider Demographics
NPI:1922090323
Name:IVES, PAUL FRED (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRED
Last Name:IVES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:145 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-1500
Mailing Address - Country:US
Mailing Address - Phone:724-872-5621
Mailing Address - Fax:724-872-6660
Practice Address - Street 1:145 N WATER ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:PA
Practice Address - Zip Code:15089-1500
Practice Address - Country:US
Practice Address - Phone:724-872-5621
Practice Address - Fax:724-872-6660
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001617760OtherHIGHMARK BCBS
PA1036189Medicaid
PAP00155884OtherPALMETTO GBA RR MEDICARE
PA0016651OtherDORAL
PA3501749OtherAETNA
PA35419OtherHLTH ASSURANCE/HLTH AMER.
PA396038OtherNVA
PA5620390OtherCIGNA
PAPA96116OtherVISION BENEFITS OF AMER.
PA35415OtherADVANTRA
PA542145620OtherVISION SERVICE PLAN
PA5463570001OtherDME REGIONAL CARRIER
PA201215OtherUPMC
PA35415OtherADVANTRA
T27354Medicare UPIN