Healthcare Provider Details

I. General information

NPI: 1437296233
Provider Name (Legal Business Name): LAUREN LYNN PELUSO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 QUINN DR
PITTSBURGH PA
15275-1013
US

IV. Provider business mailing address

2117 VENTANA DR
CORAOPOLIS PA
15108-9431
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-1691
  • Fax:
Mailing address:
  • Phone: 412-445-3674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001751
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: