Provider Demographics
NPI:1457463275
Name:CHARNETSKI, CYNTHIA G (OD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:G
Last Name:CHARNETSKI
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 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:1582 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452
Practice Address - Country:US
Practice Address - Phone:570-489-4430
Practice Address - Fax:570-307-4074
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1318122OtherHIGH MARK BLUE SHIELD
817504OtherFIRST PRIORITY HEALTH
P00212048OtherRAILROAD MEDICARE
506554OtherAETNA
83571OtherGEISINGER HEALTH PLAN
PA001863967Medicaid
83571OtherGEISINGER HEALTH PLAN
PA001863967Medicaid