Organization Active NPI

Pediatric Ophthalmology & Strabismus Inc

  • Ophthalmology Physician
  • Cranberry TWP, PA
National Provider Identifier
1285665356
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PEDIATRIC OPHTHALMOLOGY & STRABISMUS INC
Practice address
124 Graham Park Dr Ste 300
Cranberry TWP, PA 16066-8328
Phone
(724) 772-3388
Fax
(724) 772-7021
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Authorized official

Name
Michael Anthony Spavelko
Title
Operations Manager
Phone
(724) 772-3388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

124 Graham Park Dr Ste 300
Cranberry TWP, PA 16066-8328

Mailing address

124 Graham Park Dr Ste 300
Cranberry TWP, PA 16066-8328
Phone (724) 772-3388

Other practice location 1

20397 Rt 19
Ste 232
Cranberry Twp, PA 16066
Phone (724) 772-3388

Other identifiers 1

IdentifierTypeStateIssuer
0011126920003MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pedeyemd@direct-address.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041026000654 PA Part B Supplier - Clinic/Group Practice 4688635204 Receives reassigned benefits from 4 practitioners
Practice locations: Cranberry TWP, PA

National Provider Directory

National Provider Directory

Locations

124 Graham Park Dr
Ste 300
Cranberry Twp, PA 16066
Phone (724) 722-3388

124 Graham Park Dr
Cranberry Twp, PA 16066
Phone (724) 772-3388

20397 Route 19
Ste 300
Cranberry Twp, PA 16066
Phone (724) 772-3338

4750 Old William Penn Hwy
Ste 2
Murrysville, PA 15668

Interoperability endpoints

  • Direct secure messaging: pedeyemd@direct-address.org

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1285665356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 GRAHAM PARK DR STE 300",
            "city": "CRANBERRY TWP",
            "state": "PA",
            "postal_code": "160668328",
            "telephone_number": "724-772-3388",
            "fax_number": "724-772-7021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 GRAHAM PARK DR STE 300",
            "city": "CRANBERRY TWP",
            "state": "PA",
            "postal_code": "160668328",
            "telephone_number": "724-772-3388",
            "fax_number": "724-772-7021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20397 Rt 19",
            "address_2": "Ste 232",
            "address_purpose": "LOCATION",
            "city": "Cranberry Twp",
            "state": "PA",
            "postal_code": "16066",
            "country_code": "US",
            "telephone_number": "724-772-3388",
            "fax_number": "724-772-7021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC OPHTHALMOLOGY & STRABISMUS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "SPAVELKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "724-772-3388"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011126920003",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pedeyemd@direct-address.org",
            "affiliation": "N",
            "address_1": "124 Graham Park Dr Ste 300",
            "city": "Cranberry Twp",
            "state": "PA",
            "country_code": "US",
            "postal_code": "160668328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cranberry TWP, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.