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General NPI Number Information
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NPI Number | 1306929310
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Entity Type | Organization
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Legal Business Name | REDOVAN OPTICAL
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 708 N JEFFERSON ST
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City | NEW CASTLE
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State | PA
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Zip | 16101-2178
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Country | US
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Telephone | 724-658-7463
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Fax | 724-654-4499
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Provider Business Mailing Address
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Address Line | 708 N JEFFERSON ST
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City | NEW CASTLE
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State | PA
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Zip | 16101-2178
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Country | US
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Telephone | 724-658-7463
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Fax | 724-654-4499
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD G REDOVAN
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Credential | MD
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Telephone | 724-658-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 002512
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License Number State | PA
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