Provider Demographics
NPI:1366563827
Name:WERKSMAN, MARC ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROBERT
Last Name:WERKSMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 RODI RD
Mailing Address - Street 2:
Mailing Address - City:PENN HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4564
Mailing Address - Country:US
Mailing Address - Phone:412-256-2020
Mailing Address - Fax:
Practice Address - Street 1:645 RODI RD
Practice Address - Street 2:
Practice Address - City:PENN HILLS
Practice Address - State:PA
Practice Address - Zip Code:15235-4564
Practice Address - Country:US
Practice Address - Phone:412-256-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU21114Medicare UPIN