Provider Demographics
NPI:1497728919
Name:WOLF, VERONICA A (OD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:A
Other - Last Name:SIGRIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:501 HOWARD AVENUE
Mailing Address - Street 2:SUITE F1
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4818
Mailing Address - Country:US
Mailing Address - Phone:814-946-0821
Mailing Address - Fax:814-941-2520
Practice Address - Street 1:501 HOWARD AVENUE
Practice Address - Street 2:SUITE F1
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4818
Practice Address - Country:US
Practice Address - Phone:814-946-0821
Practice Address - Fax:814-941-2520
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001314152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017484550004Medicaid
PA026252Medicare UPIN
PAU74802Medicare UPIN