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General NPI Number Information
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NPI Number | 1184882797
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Entity Type | Organization
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Legal Business Name | DORMONT VISION CENTER LLC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 2893 W LIBERTY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-2619
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Country | US
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Telephone | 412-344-8534
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Fax | 412-344-6962
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Provider Business Mailing Address
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Address Line | 2893 WEST LIBERTY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-2619
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Country | US
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Telephone | 412-344-8534
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Fax | 412-344-6962
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MS. REBECCA ROBERTS DOUGLAS
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Credential | CPDC
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Telephone | 866-551-0232
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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 | OEG000494
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License Number State | PA
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