NPIMap

Individual provider Active NPI

Kameron Faychak

  • Optometrist
  • Pittsburgh, PA
National Provider Identifier
1104568708
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG003918 Issued in PA
Practice address
22 McIntyre Square Dr
Pittsburgh, PA 15237-7301
Phone
(412) 364-4700
Fax
(412) 364-4628
NPI assigned
Apr 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X OEG003918 PA Primary

Addresses

Primary practice location

22 McIntyre Square Dr
Pittsburgh, PA 15237-7301

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220725002288 PA Practitioner - Optometry 8527449347 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Pennsylvania LLCGroup PAC ID 3971884883, 118 clinicians
Aeg Pennsylvania Professional IncGroup PAC ID 7719218593, 80 clinicians

Practice addresses (Care Compare)

121 S Ctr Ave
Somerset, PA 15501-2031
Phone (814) 445-4495

124 S Pennsylvania Ave
Greensburg, PA 15601-3005
Phone (724) 837-1240

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG003918PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist CurrentSince Jul 18, 2022 Accepting new patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist CurrentSince Jul 18, 2022 Accepting new patients
The Eyeglass Shoppe, Inc. Optometrist Past Accepting new patients

Locations

125 S Antrim Way
Greencastle, PA 17225
Phone (717) 597-4780

3887 State Route 30
Latrobe, PA 15650

22 McIntyre Square Dr
Pittsburgh, PA 15237
Phone (412) 364-4700

121 S Center Ave
Somerset, PA 15501
Phone (814) 445-4495

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1104568708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MCINTYRE SQUARE DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152377301",
            "telephone_number": "412-364-4700",
            "fax_number": "412-364-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAYCHAK",
        "first_name": "KAMERON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.