Provider Demographics
NPI:1932109774
Name:SCHAVILLE, PHILIP J (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:SCHAVILLE
Suffix:
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 1:2824 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1232
Mailing Address - Country:US
Mailing Address - Phone:724-658-4505
Mailing Address - Fax:724-658-5593
Practice Address - Street 1:2824 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1232
Practice Address - Country:US
Practice Address - Phone:724-658-4505
Practice Address - Fax:724-658-5593
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU33410Medicare UPIN
PA053153Medicare PIN
PA1088770001Medicare NSC