Provider Demographics
NPI:1881695955
Name:CICHON, ANITA M (OD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:CICHON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:M
Other - Last Name:MCHIRELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V05188Medicare UPIN
PA091354Medicare ID - Type Unspecified