Provider Demographics
NPI:1265533889
Name:OPHTHALMOLOGY CONSULTANTS, PC
Entity type:Organization
Organization Name:OPHTHALMOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-741-1028
Mailing Address - Street 1:807 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8962
Mailing Address - Country:US
Mailing Address - Phone:412-741-1028
Mailing Address - Fax:412-741-1028
Practice Address - Street 1:2576 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4380
Practice Address - Country:US
Practice Address - Phone:724-378-8585
Practice Address - Fax:724-375-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044348L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014667510005Medicaid
PA101182OtherUPMC
PA0015419090007Medicaid
PA1392079OtherHIGHMARK
PA101182OtherUPMC
PA0014667510005Medicaid