Basic Information
| Provider Information | |||||||||
| NPI: | 1427043322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMONS | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | WELDON | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 S BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152181275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127312020 | ||||||||
| FaxNumber: | 4127313542 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 S BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152181275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127312020 | ||||||||
| FaxNumber: | 4127313542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG000588 | PA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 01728499 | 05 | PA | MEDICAID |