Provider Demographics
NPI:1093022394
Name:NOVAK, CAROLYN (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:NOVAK
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 1:29 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3060 CENTER VALLEY PKWY
Practice Address - Street 2:SUITE 822
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-9036
Practice Address - Country:US
Practice Address - Phone:610-791-0672
Practice Address - Fax:601-791-0713
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist