Provider Demographics
NPI:1336763101
Name:MATTHEW J. DELUCA
Entity Type:Organization
Organization Name:MATTHEW J. DELUCA
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-869-1870
Mailing Address - Street 1:400 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1737
Mailing Address - Country:US
Mailing Address - Phone:724-869-1870
Mailing Address - Fax:724-869-1313
Practice Address - Street 1:4 ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-4340
Practice Address - Country:US
Practice Address - Phone:724-869-1870
Practice Address - Fax:724-869-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0402610OtherDEA