Provider Demographics
NPI:1952685000
Name:THE EYE GALLERY OF BRENTWOOD, INC.
Entity Type:Organization
Organization Name:THE EYE GALLERY OF BRENTWOOD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KERILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-881-2626
Mailing Address - Street 1:4135 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3347
Mailing Address - Country:US
Mailing Address - Phone:412-881-2626
Mailing Address - Fax:
Practice Address - Street 1:4135 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3347
Practice Address - Country:US
Practice Address - Phone:412-881-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty