Healthcare Provider Details

I. General information

NPI: 1780640177
Provider Name (Legal Business Name): MR. JAMES CERVONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DBA QUALITY EYEWEAR

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LINCOLN AVE SUITE 100
BELLEVUE PA
15202-3550
US

IV. Provider business mailing address

575 LINCOLN AVE SUITE 100
BELLEVUE PA
15202-3550
US

V. Phone/Fax

Practice location:
  • Phone: 412-766-8875
  • Fax: 412-766-5760
Mailing address:
  • Phone: 412-766-8875
  • Fax: 412-766-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: