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General NPI Number Information
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NPI Number | 1801086913
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Entity Type | Organization
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Legal Business Name | DECONCILIS EYE AND VISION CENTER, PC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 08/30/2008
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Provider Practice Location Address
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Address Line | 950 S CENTRAL AVE SUITE 1
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City | CANONSBURG
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State | PA
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Zip | 15317-1489
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Country | US
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Telephone | 724-745-2020
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Fax | 724-745-4888
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Provider Business Mailing Address
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Address Line | 950 S CENTRAL AVE SUITE 1
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City | CANONSBURG
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State | PA
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Zip | 15317-1489
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Country | US
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Telephone | 724-745-2020
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Fax | 724-745-4888
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALE L DECONCILIS
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Credential | O.D.
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Telephone | 724-745-2020
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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 | OEG000998
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License Number State | PA
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