Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG001242 | PA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG001242 | PA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OEG001242 | PA |
N | 152WP0200X | Pediatric Optomitrist | OEG001242 | PA |
N | 152WS0006X | Sports Vision | OEG001242 | PA |
N | 152WV0400X | Optomitrist - Vision Therapist | OEG001242 | PA |
N | 152WX0102X | Occupational Vision | OEG001242 | PA |
NPI | 1205834926 |
---|---|
Provider Name | Dr. Lois Jean Wida |
First Address | Reinholds, PA 17569-9640 |
Second Address | Reinholds, PA 17569-9640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00254773 | RAILROAD MEDICARE (01) | PA |
T89398 | (02) | PA |