Provider Demographics
NPI:1265522148
Name:TESLA, NICHOLAS (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:TESLA
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 1:461 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1253
Mailing Address - Country:US
Mailing Address - Phone:412-341-1441
Mailing Address - Fax:412-341-1184
Practice Address - Street 1:461 COCHRAN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1253
Practice Address - Country:US
Practice Address - Phone:412-341-1441
Practice Address - Fax:412-341-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOB006370G152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU10729Medicare UPIN