Provider Demographics
NPI:1356504724
Name:POUVOIR COMPANY LLC
Entity type:Organization
Organization Name:POUVOIR COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-626-3937
Mailing Address - Street 1:110 S PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3506
Mailing Address - Country:US
Mailing Address - Phone:724-626-3937
Mailing Address - Fax:724-626-8332
Practice Address - Street 1:110 S PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3506
Practice Address - Country:US
Practice Address - Phone:724-626-3937
Practice Address - Fax:724-626-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000488332H00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4579120001Medicare NSC