Provider Demographics
NPI:1306825591
Name:FEDORIW, IHOR N (OD)
Entity Type:Individual
Prefix:
First Name:IHOR
Middle Name:N
Last Name:FEDORIW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-5057
Mailing Address - Country:US
Mailing Address - Phone:610-434-1371
Mailing Address - Fax:610-437-6982
Practice Address - Street 1:1320 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-5057
Practice Address - Country:US
Practice Address - Phone:610-434-1371
Practice Address - Fax:610-437-6982
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0339210001Medicare NSC
U07920Medicare UPIN
284988Medicare PIN