MEDICARE: DECONCILIS EYE AND VISION CENTER, PC

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	OEG000998	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DN2099	OTHER	PA	RAILROAD MEDICARE PART B GROUP PTAN
4	P00609148	OTHER	PA	RAILROAD MEDICARE PART B GROUP MEMBER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801086913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECONCILIS EYE AND VISION CENTER, PC

Provider Business Mailing Address
First Line	:	950 S CENTRAL AVE
Second Line	:	SUITE 1
City	:	CANONSBURG
State	:	PA
Zip	:	15317-1489
Country	:	US
Telephone Number	:	724-745-2020
Fax Number	:	724-745-4888

Provider Business Practice Location Address
First Line	:	950 S CENTRAL AVE
Second Line	:	SUITE 1
City	:	CANONSBURG
State	:	PA
Zip	:	15317-1489
Country	:	US
Telephone Number	:	724-745-2020
Fax Number	:	724-745-4888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DALE L DECONCILIS
Credential	:	O.D.
Telephone Number	:	724-745-2020

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	08/30/2008

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Directions to “DECONCILIS EYE AND VISION CENTER, PC ” Practice Location

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