| |
3090 N Susquehanna Trail Rd, Shamokin Dam, PA 17876 | |
(570) 743-3937 | |
(570) 743-3005 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 3090 N Susquehanna Trail Rd, Shamokin Dam, Pennsylvania |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1407098908 | NPI | - | NPPES |
0018518950002 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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4119 Mauch Chunk Rd # C, Coplay, PA 18037-2106 Ph: (610) 799-2020 | 3090 N Susquehanna Trail Rd, Shamokin Dam, PA 17876 Ph: (570) 743-3937 |