Provider Demographics
NPI:1205191731
Name:KRAVCHENKO, MARYANA N (OD)
Entity Type:Individual
Prefix:
First Name:MARYANA
Middle Name:N
Last Name:KRAVCHENKO
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 1:2068 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-3653
Mailing Address - Country:US
Mailing Address - Phone:267-575-5669
Mailing Address - Fax:
Practice Address - Street 1:453 S OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-4202
Practice Address - Country:US
Practice Address - Phone:215-547-5470
Practice Address - Fax:215-547-7877
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist