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General NPI Number Information
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NPI Number | 1063524726
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Entity Type | Organization
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Legal Business Name | LAWRENCEVILLE VISION CARE, P.C.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/12/2010
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Provider Practice Location Address
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Address Line | 4122 BUTLER ST
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City | PITTSBURGH
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State | PA
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Zip | 15201-3162
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Country | US
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Telephone | 412-682-2339
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Fax | 412-682-2809
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Provider Business Mailing Address
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Address Line | 4122 BUTLER ST
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City | PITTSBURGH
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State | PA
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Zip | 15201-3162
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Country | US
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Telephone | 412-682-2339
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Fax | 412-682-2809
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIELLE K STARESINIC
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Credential | OD
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Telephone | 412-682-2339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000851
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License Number State | PA
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