Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | OC000894L | PA |
NPI | 1225399827 |
---|---|
Provider Name | Bernadette Wilk Anderson |
First Address | Lancaster, PA 17603-3512 |
Second Address | Lancaster, PA 17603-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2012 |