Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 0618001621 | VA |
Y | 152W00000X | Optometrist | OEG001865 | PA |
NPI | 1003988296 |
---|---|
Provider Name | Dr. Alicia Nichole Telega |
First Address | Pittsburgh, PA 15232-1741 |
Second Address | Pittsburgh, PA 15232-1741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V12109 | (02) |