Healthcare Provider Details

I. General information

NPI: 1770575482
Provider Name (Legal Business Name): MOSSIDE OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 MOSSIDE BLVD
MONROEVILLE PA
15146-3510
US

IV. Provider business mailing address

2571 MOSSIDE BLVD
MONROEVILLE PA
15146-3510
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-8885
  • Fax: 412-856-1340
Mailing address:
  • Phone: 412-856-8885
  • Fax: 412-856-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL J AZAR
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 412-856-8885