Provider Demographics
NPI:1467605964
Name:TRYBULSKI, DAWN MARLENE (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARLENE
Last Name:TRYBULSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARLENE
Other - Last Name:D'ANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:309 WASHINGTON ST
Mailing Address - Street 2:APT 2424
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1974
Mailing Address - Country:US
Mailing Address - Phone:817-964-9983
Mailing Address - Fax:
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:BMH MOB NORTH, SUITE 100
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-527-0990
Practice Address - Fax:610-527-7921
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA145009E45Medicare PIN