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General NPI Number Information
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NPI Number | 1619549565
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Entity Type | Individual
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Provider Name | KIMBERLY ROSE FAZIO OD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1816 LOCUST ST
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City | PITTSBURGH
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State | PA
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Zip | 15219-5920
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Country | US
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Telephone | 412-368-4400
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Fax | 412-368-4091
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Provider Business Mailing Address
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Address Line | 1816 LOCUST ST
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City | PITTSBURGH
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State | PA
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Zip | 15219-5920
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Country | US
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Telephone | 412-368-4400
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Fax | 123-684-0914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG003774
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License Number State | PA
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