Organization
DECONCILIS EYE AND VISION CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE L DECONCILIS O.D. (PRESIDENT)
(724) 745-2020
Entity
Organization
Contact information
Practice address
950 S CENTRAL AVE, SUITE 1, CANONSBURG, PA 15317-1489
(724) 745-2020
(724) 745-4888
Mailing address
950 S CENTRAL AVE, SUITE 1, CANONSBURG, PA 15317-1489
(724) 745-2020
(724) 745-4888
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000998
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001193064
—
PA
05
—
101014498
—
PA
01
—
DN2099
RAILROAD MEDICARE PART B GROUP PTAN
PA
01
—
P00609148
RAILROAD MEDICARE PART B GROUP MEMBER PTAN
PA
Enumeration date
07/26/2007
Last updated
08/30/2008
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