NPIMap

Organization Active NPI

Aeg Pennsylvania Professional, Inc

Doing business as Eyetique- Squirrel Hill

  • Optometrist
  • Pittsburgh, PA
National Provider Identifier
1316956030
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG PENNSYLVANIA PROFESSIONAL, INC
Doing business as
Eyetique- Squirrel Hill
Practice address
2242 Murray Ave
Pittsburgh, PA 15217
Phone
(412) 422-5300
Fax
(314) 741-4947
NPI assigned
Aug 5, 2006
Last updated
Nov 14, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
AEG PENNSYLVANIA PROFESSIONAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Benjamin Chudner
Title
Owner
Phone
(360) 620-1186

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

2242 Murray Ave
Pittsburgh, PA 15217

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818

Other names 1

  • Eyetique- Squirrel Hill Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110414000546 PA Part B Supplier - Clinic/Group Practice 6002090107 Receives reassigned benefits from 20 practitioners
Practice locations: Pittsburgh, PA; Wexford, PA; Warrendale, PA; Sewickley, PA; Pleasant Hills, PA; Mars, PA; Greensburg, PA

National Provider Directory

National Provider Directory
Tax ID family
Eyetique Corporation10 organizations share this tax ID, including this one
Part of
Aeg Pennsylvania Prof Inc

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

535 Adams Shoppes
#3
Mars, PA 16046
Phone (724) 591-8515

810 Clairton Blvd
Ste 200
Pleasant Hills, PA 15236
Phone (412) 244-3054

10644 Perry Hwy
Wexford, PA 15090
Phone (724) 940-5300

4835 Lyndon B Johnson Fwy
Ste 850
Dallas, TX 75244

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1316956030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2242 MURRAY AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "15217",
            "telephone_number": "412-422-5300",
            "fax_number": "314-741-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG PENNSYLVANIA PROFESSIONAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AEG PENNSYLVANIA PROFESSIONAL, INC",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "CHUDNER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-620-1186"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyetique- Squirrel Hill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsburgh, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.