Healthcare Provider Details

I. General information

NPI: 1033363288
Provider Name (Legal Business Name): SIDNEY COHEN OD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E CARSON ST
PITTSBURGH PA
15203-1836
US

IV. Provider business mailing address

1900 E CARSON ST
PITTSBURGH PA
15203-1836
US

V. Phone/Fax

Practice location:
  • Phone: 412-431-5300
  • Fax: 412-431-5315
Mailing address:
  • Phone: 412-431-5300
  • Fax: 412-431-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000538
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOEG000538
License Number StatePA

VIII. Authorized Official

Name: DR. BARRY COHEN
Title or Position: OWNER
Credential: OD
Phone: 412-431-5300