Provider Demographics
NPI:1437279338
Name:WOLAK, VICTORIA L (OD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:WOLAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:L
Other - Last Name:ONDIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-0001
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-1506
Practice Address - Fax:573-884-5575
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003848152W00000X
MO2007032814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO314607300Medicaid
MOP00601092Medicare PIN
U68592Medicare UPIN
MO261725236Medicare PIN