Provider Demographics
NPI:1811079627
Name:THEODORE R. SAMES, JR., O.D.
Entity type:Organization
Organization Name:THEODORE R. SAMES, JR., O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:412-831-7757
Mailing Address - Street 1:4706 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2873
Mailing Address - Country:US
Mailing Address - Phone:412-831-7757
Mailing Address - Fax:412-854-3252
Practice Address - Street 1:4706 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2873
Practice Address - Country:US
Practice Address - Phone:412-831-7757
Practice Address - Fax:412-854-3252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTICAL IMAGES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011379400004Medicaid
PAT98260OtherHEALTHAMERICA
PA452689OtherAETNA
PA6363107OtherCIGNA
PA1688547OtherHIGHMARK
PA206767OtherUPMC
PA452689OtherAETNA
PA532373Medicare PIN
PA6363107OtherCIGNA