Provider Demographics
NPI:1407955230
Name:HOMA-PALLADINO, MARIE T (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:T
Last Name:HOMA-PALLADINO
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 1:1776 E LANCASTER AVE
Mailing Address - Street 2:2
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1550
Mailing Address - Country:US
Mailing Address - Phone:610-647-2502
Mailing Address - Fax:
Practice Address - Street 1:1776 E LANCASTER AVE
Practice Address - Street 2:2
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1550
Practice Address - Country:US
Practice Address - Phone:610-647-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA552082ZFJOtherMEDICARE PTAN