Provider Demographics
NPI:1093806226
Name:MCDONALD, FLORENCE ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:ELIZABETH
Last Name:MCDONALD
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 1:116 HULL DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9126
Mailing Address - Country:US
Mailing Address - Phone:717-292-9351
Mailing Address - Fax:
Practice Address - Street 1:855 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4934
Practice Address - Country:US
Practice Address - Phone:717-843-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005024T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019699840001Medicaid
PA019699840001Medicaid
PA18782Medicare UPIN