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General NPI Number Information
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NPI Number | 1376677179
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Entity Type | Organization
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Legal Business Name | EYES ON REGENT SQUARE
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1201 S BRADDOCK AVE
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City | PITTSBURGH
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State | PA
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Zip | 15218-1275
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Country | US
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Telephone | 412-731-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S BRADDOCK AVE
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City | PITTSBURGH
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State | PA
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Zip | 15218-1275
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Country | US
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Telephone | 412-731-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAUREEN WELDON KAMONS
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Credential | OD
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Telephone | 412-731-2020
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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 | OEG-000588
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License Number State | PA
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