Healthcare Provider Details

I. General information

NPI: 1548281066
Provider Name (Legal Business Name): JASON M WASYLOVSKI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 QUINN DR
PITTSBURGH PA
15275-1013
US

IV. Provider business mailing address

460 MARKMAN PARK RD
BADEN PA
15005-2838
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-1691
  • Fax:
Mailing address:
  • Phone: 347-678-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000079
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: