Healthcare Provider Details

I. General information

NPI: 1629127683
Provider Name (Legal Business Name): PEDIATRIC OPHTHALMOLOGY OF ERIE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W 12TH ST SUITE 301
ERIE PA
16501
US

IV. Provider business mailing address

128 W 12TH ST SUITE 301
ERIE PA
16501-1750
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-6307
  • Fax: 814-454-6397
Mailing address:
  • Phone: 814-454-6307
  • Fax: 814-454-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS A SALA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 814-454-6307