=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841458650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL CENTER OPTICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2008
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3524 5TH AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15213-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-621-6773
-----------------------------------------------------
Fax | 412-621-4611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3524 5TH AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15213-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-621-6773
-----------------------------------------------------
Fax | 412-621-4611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EARL GLASSER
-----------------------------------------------------
Credential | OPTICIAN
-----------------------------------------------------
Telephone | 412-621-6773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------