Basic Information
| Provider Information | |||||||||
| NPI: | 1336255397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEXFORD OPTICAL ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2242 MURRAY AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152172308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124225300 | ||||||||
| FaxNumber: | 4124225360 | ||||||||
| Practice Location | |||||||||
| Address1: | 10644 PERRY HWY | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249405300 | ||||||||
| FaxNumber: | 7249405304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHILDS | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4124225300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.