Provider Demographics
NPI:1326122078
Name:SERNIAK, JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:SERNIAK
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 1:225 COLUMBIA MALL DR
Mailing Address - Street 2:STE 56
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8368
Mailing Address - Country:US
Mailing Address - Phone:570-387-8081
Mailing Address - Fax:
Practice Address - Street 1:100 LUNGER DR
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8330
Practice Address - Country:US
Practice Address - Phone:570-387-5239
Practice Address - Fax:570-387-5294
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE 007070 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA546973Medicare ID - Type Unspecified