Healthcare Provider Details

I. General information

NPI: 1841281714
Provider Name (Legal Business Name): NICHOLAS SALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/24/2021
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W 12TH ST SUITE 301
ERIE PA
16501-1750
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS006347L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: