Provider Demographics
NPI:1962573469
Name:CSONKA OPTOMETRIC PC
Entity type:Organization
Organization Name:CSONKA OPTOMETRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CSONKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-364-4090
Mailing Address - Street 1:6013 BABCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2502
Mailing Address - Country:US
Mailing Address - Phone:412-364-4090
Mailing Address - Fax:412-364-7990
Practice Address - Street 1:6013 BABCOCK BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2502
Practice Address - Country:US
Practice Address - Phone:412-364-4090
Practice Address - Fax:412-364-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000820152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0664580001Medicare NSC
PA020966Medicare ID - Type Unspecified