=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821325960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASTRANGELOS EYEWORKS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2009
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2714 MERCER RD SCHENLEY SQUARE
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16105-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-654-1257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2714 MERCER RD SCHENLEY SQUARE
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16105-1422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-654-1257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBORAH MARTIN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 724-654-1257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | OEG000845
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------