Provider Demographics
NPI:1083719744
Name:EYE PHYSICIANS OPTICAL LLC
Entity type:Organization
Organization Name:EYE PHYSICIANS OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIST
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-940-4086
Mailing Address - Street 1:7000 STONEWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7376
Mailing Address - Country:US
Mailing Address - Phone:724-940-4001
Mailing Address - Fax:
Practice Address - Street 1:7000 STONEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-940-4086
Practice Address - Fax:724-940-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4141920001Medicare NSC
PA4141920001Medicare NSC