Provider Demographics
NPI:1679610521
Name:BALOURIS EYE CENER, PC
Entity type:Organization
Organization Name:BALOURIS EYE CENER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-482-0090
Mailing Address - Street 1:102 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1782
Mailing Address - Country:US
Mailing Address - Phone:724-482-0090
Mailing Address - Fax:724-482-0093
Practice Address - Street 1:102 TECHNOLOGY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1782
Practice Address - Country:US
Practice Address - Phone:724-482-0090
Practice Address - Fax:724-482-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADD7831OtherRAILROAD MEDICARE
PA001691450Medicaid
PA1501183OtherGATEWAY
PA1755548OtherHIGHMARK
PA001691450Medicaid
PA1186970001Medicare NSC