Provider Demographics
NPI:1063402808
Name:WESTERN PA EYE PHYS AND SURGEONS
Entity type:Organization
Organization Name:WESTERN PA EYE PHYS AND SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:ZAMBELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-728-5000
Mailing Address - Street 1:380 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2138
Mailing Address - Country:US
Mailing Address - Phone:724-728-5000
Mailing Address - Fax:724-728-3248
Practice Address - Street 1:380 ADAMS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2138
Practice Address - Country:US
Practice Address - Phone:724-728-5000
Practice Address - Fax:724-728-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019985E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA060837OtherPABS
PA206043OtherUPMC
PA5470440OtherCIGNA
PAE55440OtherCOVENTRY
PA1503486OtherGATEWAY
PA0007420720001Medicaid
PA180000534OtherRAILROAD MEDICARE
PA91740OtherAETNA
PA=========OtherUHWA
E55440Medicare UPIN
PA1503486OtherGATEWAY