Healthcare Provider Details

I. General information

NPI: 1710378427
Provider Name (Legal Business Name): ALLEGHENY EYE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 LEECHBURG RD
LOWER BURRELL PA
15068-2527
US

IV. Provider business mailing address

2800 LEECHBURG RD
LOWER BURRELL PA
15068-2527
US

V. Phone/Fax

Practice location:
  • Phone: 724-335-7799
  • Fax: 724-335-7794
Mailing address:
  • Phone: 724-335-7799
  • Fax: 724-335-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0EG002370
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN MICHAEL SHIELDS
Title or Position: OWNER
Credential: O.D.
Phone: 724-335-7799