Provider Demographics
NPI:1417915877
Name:WOLFE, KARL WRAY (OD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:WRAY
Last Name:WOLFE
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 1:968 SOUTH ST MARYS RD
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-781-3384
Mailing Address - Fax:814-781-3389
Practice Address - Street 1:968 SOUTH ST MARYS RD
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-781-3384
Practice Address - Fax:814-781-3389
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
306064OtherUPMC
397409OtherNVA
43133400001OtherDMERCA
65105OtherKEYSTONE BLUE
PA6484OtherEYEMED
1318797OtherBLUE CROSS BLUE SHIELD
1318797OtherBLUE CROSS BLUE SHIELD
PA6484OtherEYEMED