Provider Demographics
NPI:1033133830
Name:MEDINA, SYLVIA (OD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:MEDINA
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 1:2037 STEFKO BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5444
Mailing Address - Country:US
Mailing Address - Phone:610-419-6444
Mailing Address - Fax:610-866-9462
Practice Address - Street 1:2037 STEFKO BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-5444
Practice Address - Country:US
Practice Address - Phone:610-419-6444
Practice Address - Fax:610-866-9462
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001366152W00000X
NYTUV006744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102486199 0002Medicaid
PA102486199 0002Medicaid