Healthcare Provider Details

I. General information

NPI: 1952685000
Provider Name (Legal Business Name): THE EYE GALLERY OF BRENTWOOD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 BROWNSVILLE RD
PITTSBURGH PA
15227-3347
US

IV. Provider business mailing address

4135 BROWNSVILLE RD
PITTSBURGH PA
15227-3347
US

V. Phone/Fax

Practice location:
  • Phone: 412-881-2626
  • Fax:
Mailing address:
  • Phone: 412-881-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL DAVID KERILA
Title or Position: PRESIDENT
Credential:
Phone: 412-881-2626