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General NPI Number Information
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NPI Number | 1629127683
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OPHTHALMOLOGY OF ERIE, INC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 128 W 12TH ST SUITE 301
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City | ERIE
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State | PA
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Zip | 16501
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Country | US
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Telephone | 814-454-6307
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Fax | 814-454-6397
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Provider Business Mailing Address
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Address Line | 128 W 12TH ST SUITE 301
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City | ERIE
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State | PA
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Zip | 16501-1750
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Country | US
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Telephone | 814-454-6307
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Fax | 814-454-6397
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS A SALA
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Credential | D.O.
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Telephone | 814-454-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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