Provider Demographics
NPI:1104041508
Name:MARCZAK, MONIKA AGNIESZKA (OD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:AGNIESZKA
Last Name:MARCZAK
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 1:1761 MOYNELLE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1635
Mailing Address - Country:US
Mailing Address - Phone:412-805-1676
Mailing Address - Fax:
Practice Address - Street 1:4007 WASHINGTON RD
Practice Address - Street 2:DONALDSON'S CROSSROADS
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2520
Practice Address - Country:US
Practice Address - Phone:724-941-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001269152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU97903Medicare UPIN