Healthcare Provider Details

I. General information

NPI: 1932109774
Provider Name (Legal Business Name): PHILIP J SCHAVILLE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 WILMINGTON RD
NEW CASTLE PA
16105-1232
US

IV. Provider business mailing address

2824 WILMINGTON RD
NEW CASTLE PA
16105-1232
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-4505
  • Fax: 724-658-5593
Mailing address:
  • Phone: 724-658-4505
  • Fax: 724-658-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000380
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: