Provider Demographics
NPI:1043296429
Name:NEIL G. CALLAHAN O.D., P.C.
Entity type:Organization
Organization Name:NEIL G. CALLAHAN O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-346-2020
Mailing Address - Street 1:2926 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2757
Mailing Address - Country:US
Mailing Address - Phone:724-346-2020
Mailing Address - Fax:724-346-1121
Practice Address - Street 1:2926 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2757
Practice Address - Country:US
Practice Address - Phone:724-346-2020
Practice Address - Fax:724-346-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087969Medicare ID - Type UnspecifiedMEDICARE NUM.
PAU97114Medicare UPIN