=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265533889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPHTHALMOLOGY CONSULTANTS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 12/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2576 BRODHEAD RD
-----------------------------------------------------
City | ALIQUIPPA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15001-4380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-378-8585
-----------------------------------------------------
Fax | 724-375-1574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 807 TIMBER LN
-----------------------------------------------------
City | SEWICKLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15143-8962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-741-1028
-----------------------------------------------------
Fax | 412-741-1028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAURA A PALLAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 412-741-1028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD044348L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------