Healthcare Provider Details

I. General information

NPI: 1134067382
Provider Name (Legal Business Name): KEVIN POLLOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 N KERRWOOD DR
HERMITAGE PA
16148-5202
US

IV. Provider business mailing address

4051 THOMASON RD
SHARPSVILLE PA
16150-9248
US

V. Phone/Fax

Practice location:
  • Phone: 724-342-2733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004363
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: