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General NPI Number Information
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NPI Number | 1881855211
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Entity Type | Organization
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Legal Business Name | NICOLE D BOSAK OD INC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 4960 WILLIAM FLYNN HWY SUITE 13
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City | ALLISON PARK
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State | PA
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Zip | 15101-2354
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Country | US
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Telephone | 724-444-1149
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 WILLIAM FLYNN HWY SUITE 16
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City | ALLISON PARK
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State | PA
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Zip | 15101
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Country | US
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Telephone | 724-444-1149
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | NICOLE DIANE LIGGETT
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Credential | OD
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Telephone | 724-443-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OEG000498
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License Number State | PA
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