Provider Demographics
NPI:1023222387
Name:SULC, MIRKA (OD)
Entity Type:Individual
Prefix:DR
First Name:MIRKA
Middle Name:
Last Name:SULC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 FARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4211
Mailing Address - Country:US
Mailing Address - Phone:724-776-1715
Mailing Address - Fax:
Practice Address - Street 1:1717 ROUTE 228
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5312
Practice Address - Country:US
Practice Address - Phone:724-778-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008538152W00000X
PAOEG001311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167090Q1AMedicare PIN