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General NPI Number Information
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NPI Number | 1679686810
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Entity Type | Individual
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Provider Name | TAL ASHER BARAK O.D
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 202 COSTCO DR OPTICAL DEPARTMENT
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City | PITTSBURGH
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State | PA
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Zip | 15205-4858
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Country | US
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Telephone | 626-318-6930
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Fax | 412-490-2226
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Provider Business Mailing Address
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Address Line | 202 COSTCO DR OPTICAL DEPARTMENT
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City | PITTSBURGH
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State | PA
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Zip | 15205-4858
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Country | US
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Telephone | 626-318-6930
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Fax | 412-490-2226
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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 | 11603T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002553
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License Number State | PA
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