Provider Demographics
NPI:1952393662
Name:EAST SUBURBAN OPHTHALMIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EAST SUBURBAN OPHTHALMIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-856-8811
Mailing Address - Street 1:2571 MOSSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3510
Mailing Address - Country:US
Mailing Address - Phone:412-856-8811
Mailing Address - Fax:412-856-4481
Practice Address - Street 1:2571 MOSSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3510
Practice Address - Country:US
Practice Address - Phone:412-856-8811
Practice Address - Fax:412-856-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
087919Medicare ID - Type Unspecified
PA087919Medicare PIN