MEDICARE: NICOLE D BOSAK OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	OEG000498	PA

General Provider Information

NPI Number	:	1881855211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE D BOSAK OD INC

Provider Business Mailing Address
First Line	:	4960 WILLIAM FLYNN HWY
Second Line	:	SUITE 16
City	:	ALLISON PARK
State	:	PA
Zip	:	15101
Country	:	US
Telephone Number	:	724-444-1149
Fax Number	:

Provider Business Practice Location Address
First Line	:	4960 WILLIAM FLYNN HWY
Second Line	:	SUITE 13
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-2354
Country	:	US
Telephone Number	:	724-444-1149
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	NICOLE DIANE LIGGETT
Credential	:	OD
Telephone Number	:	724-443-5060

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	09/12/2025

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