Provider Demographics
NPI:1255606034
Name:OUTLOOK OPTOMETRY LLC
Entity type:Organization
Organization Name:OUTLOOK OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-274-0276
Mailing Address - Street 1:8131 POST RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3334
Mailing Address - Country:US
Mailing Address - Phone:724-612-3943
Mailing Address - Fax:724-274-0278
Practice Address - Street 1:2010 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-3850
Practice Address - Country:US
Practice Address - Phone:724-274-0274
Practice Address - Fax:724-274-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100949845Medicaid
PA100949845Medicaid