Provider Demographics
NPI:1184669095
Name:GJURICH, DANA C (OD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:C
Last Name:GJURICH
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 1:108 OLDE FARM OFFICE ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-9417
Mailing Address - Country:US
Mailing Address - Phone:814-695-3141
Mailing Address - Fax:814-696-4780
Practice Address - Street 1:108 OLDE FARM OFFICE ROAD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-9417
Practice Address - Country:US
Practice Address - Phone:814-695-3141
Practice Address - Fax:814-696-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410028148OtherMEDICARE RAILROAD
000786558OtherHIGHMARK
PA0015786960003Medicaid
251387446OtherUNITED HEALTHCARE
251387446OtherUNITED HEALTHCARE
PAU56500Medicare UPIN