=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649458233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOOLAHAN OPTOMETRIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2008
-----------------------------------------------------
Last Update Date | 11/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 818 CEDAR AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-321-3444
-----------------------------------------------------
Fax | 412-321-3267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 818 CEDAR AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-321-3444
-----------------------------------------------------
Fax | 412-321-3267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAUL JOHN HOOLAHAN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 412-321-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG000666T
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------