Provider Demographics
NPI:1811308885
Name:EYE COUTURE OPTICAL PC
Entity type:Organization
Organization Name:EYE COUTURE OPTICAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CICHON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-851-2020
Mailing Address - Street 1:5217 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2714
Mailing Address - Country:US
Mailing Address - Phone:412-851-2020
Mailing Address - Fax:412-851-2022
Practice Address - Street 1:5217 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2714
Practice Address - Country:US
Practice Address - Phone:412-851-2020
Practice Address - Fax:412-851-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG001465OtherOPTOMETRIST LICENSE