Provider Demographics
NPI:1841281714
Name:SALA, NICHOLAS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 12TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 W 12TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1750
Practice Address - Country:US
Practice Address - Phone:814-454-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006347L207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012724900007Medicaid
PA506007Medicare ID - Type Unspecified
PA0012724900007Medicaid