Provider Demographics
NPI:1134334055
Name:NORTHWEST EYE ASSOCIATES INC
Entity type:Organization
Organization Name:NORTHWEST EYE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:S
Authorized Official - Last Name:VIRGILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-437-2444
Mailing Address - Street 1:312 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1335
Mailing Address - Country:US
Mailing Address - Phone:814-437-2444
Mailing Address - Fax:
Practice Address - Street 1:312 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1335
Practice Address - Country:US
Practice Address - Phone:814-437-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110073556OtherPIN