Healthcare Provider Details

I. General information

NPI: 1477739274
Provider Name (Legal Business Name): MGM OPTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PENN CENTER BLVD SUITE 100
PITTSBURGH PA
15235-5435
US

IV. Provider business mailing address

201 PENN CENTER BLVD STE 100
PITTSBURGH PA
15235-5435
US

V. Phone/Fax

Practice location:
  • Phone: 412-824-1755
  • Fax:
Mailing address:
  • Phone: 412-824-1755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW G MOMICH
Title or Position: OWNER
Credential:
Phone: 412-824-1755