Provider Demographics
NPI:1487823548
Name:KARL W WOLFE,OD
Entity Type:Organization
Organization Name:KARL W WOLFE,OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:WRAY
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-781-3384
Mailing Address - Street 1:968 S SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2833
Mailing Address - Country:US
Mailing Address - Phone:814-781-3384
Mailing Address - Fax:814-781-3389
Practice Address - Street 1:968 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2833
Practice Address - Country:US
Practice Address - Phone:814-781-3384
Practice Address - Fax:814-781-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4313340001Medicare NSC