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General NPI Number Information
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NPI Number | 1326233206
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Entity Type | Organization
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Legal Business Name | PAVILION OPTICAL
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 4815 LIBERTY AVE M-25
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City | PITTSBURGH
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State | PA
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Zip | 15224-2156
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Country | US
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Telephone | 412-621-7038
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Fax | 412-578-1166
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Provider Business Mailing Address
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Address Line | 4815 LIBERTY AVE M-25
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City | PITTSBURGH
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State | PA
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Zip | 15224-2156
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Country | US
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Telephone | 412-621-7038
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Fax | 412-578-1166
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN J GUEHL
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Credential | DO
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Telephone | 412-621-7098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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