Provider Demographics
NPI:1114990488
Name:WAHI, KOMAL (OD)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:WAHI
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 1:567 ROUTE 100 N
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:BECHTELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19505-9263
Mailing Address - Country:US
Mailing Address - Phone:610-367-1076
Mailing Address - Fax:
Practice Address - Street 1:567 ROUTE 100 N
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:BECHTELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19505-9263
Practice Address - Country:US
Practice Address - Phone:610-367-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
086514M3YMedicare ID - Type Unspecified
V02728Medicare UPIN