Provider Demographics
NPI:1265562276
Name:WEST PENN ALLEGHENY EYE ASSOCIATES, PC
Entity type:Organization
Organization Name:WEST PENN ALLEGHENY EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-621-7038
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:M25
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-621-7038
Mailing Address - Fax:412-578-1166
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:M25
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-621-7038
Practice Address - Fax:412-578-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016396750003Medicaid
PAWE416719Medicare PIN