Provider Demographics
NPI:1386825644
Name:DR. WAYNE A. MUNDIS
Entity Type:Organization
Organization Name:DR. WAYNE A. MUNDIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MUNDIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-235-1346
Mailing Address - Street 1:46 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-1011
Mailing Address - Country:US
Mailing Address - Phone:717-235-1346
Mailing Address - Fax:717-235-4843
Practice Address - Street 1:46 WATER ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:PA
Practice Address - Zip Code:17327-1011
Practice Address - Country:US
Practice Address - Phone:717-235-1346
Practice Address - Fax:717-235-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5274-P332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0516520001OtherDMERC REGION A