Provider Demographics
NPI:1033941588
Name:OBISIDIAN EXCEPTIONAL EYEWEAR LLC
Entity type:Organization
Organization Name:OBISIDIAN EXCEPTIONAL EYEWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-427-7405
Mailing Address - Street 1:202 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2521
Mailing Address - Country:US
Mailing Address - Phone:412-427-7405
Mailing Address - Fax:
Practice Address - Street 1:4603 LIBRARY RD STE 225
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-6901
Practice Address - Country:US
Practice Address - Phone:412-427-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier