Healthcare Provider Details

I. General information

NPI: 1992713184
Provider Name (Legal Business Name): OPTOMETRIC CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 LINCOLN AVE
BELLEVUE PA
15202-3548
US

IV. Provider business mailing address

2576 BRODHEAD RD
ALIQUIPPA PA
15001-4380
US

V. Phone/Fax

Practice location:
  • Phone: 412-766-8875
  • Fax: 412-766-5760
Mailing address:
  • Phone: 724-378-8585
  • Fax: 724-375-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001209
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000767
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000609
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD044348L
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000668
License Number StatePA

VIII. Authorized Official

Name: MRS. CHRISTINE R MADRON
Title or Position: OFFICE MANAGER
Credential:
Phone: 724-378-8585