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General NPI Number Information
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NPI Number | 1285665356
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OPHTHALMOLOGY & STRABISMUS INC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 124 GRAHAM PARK DR STE 300
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-8328
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Country | US
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Telephone | 724-772-3388
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Fax | 724-772-7021
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Provider Business Mailing Address
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Address Line | 124 GRAHAM PARK DR STE 300
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-8328
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Country | US
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Telephone | 724-772-3388
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Fax | 724-772-7021
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MICHAEL ANTHONY SPAVELKO
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Credential |
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Telephone | 724-772-3388
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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