Healthcare Provider Details

I. General information

NPI: 1114935525
Provider Name (Legal Business Name): VISUALEYES OF PENNSYLVANIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 RIDGE RD SUITE 100
PITTSBURGH PA
15205-9503
US

IV. Provider business mailing address

650 RIDGE RD SUITE 100
PITTSBURGH PA
15205-9503
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-4664
  • Fax: 412-788-6003
Mailing address:
  • Phone: 412-788-4664
  • Fax: 412-788-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS R. STAHL
Title or Position: OPTOMETRIST
Credential: OD
Phone: 937-258-1515