Provider Demographics
NPI:1083192744
Name:O'NEAL, LOGAN ELAINE (OD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:ELAINE
Last Name:O'NEAL
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 1:4392 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3674
Mailing Address - Country:US
Mailing Address - Phone:717-652-7710
Mailing Address - Fax:
Practice Address - Street 1:4392 STURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3674
Practice Address - Country:US
Practice Address - Phone:717-652-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist