MEDICARE: GIANT EAGLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001269	PA

General Provider Information

NPI Number	:	1407097504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIANT EAGLE INC

Provider Business Mailing Address
First Line	:	101 KAPPA DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2809
Country	:	US
Telephone Number	:	412-968-5159
Fax Number	:	412-968-5115

Provider Business Practice Location Address
First Line	:	4007 WASHINGTON RD
Second Line	:	DONALDSONS CROSSROADS
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-941-5100
Fax Number	:	724-941-5380

Authorized Official
Title or Position	:	MANAGER OPTICAL DEPT
Name	:	NATALIE DOHN
Credential	:
Telephone Number	:	412-968-5159

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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