Provider Demographics
NPI:1649441908
Name:BRENTWOOD CARRICK OPTICAL CENTER,INC
Entity type:Organization
Organization Name:BRENTWOOD CARRICK OPTICAL CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAWRANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-881-2626
Mailing Address - Street 1:4135 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3347
Mailing Address - Country:US
Mailing Address - Phone:412-881-2626
Mailing Address - Fax:
Practice Address - Street 1:4135 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3347
Practice Address - Country:US
Practice Address - Phone:412-881-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier