Provider Demographics
NPI:1568496495
Name:WOLANIUK, DEBRA L (OD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:WOLANIUK
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 1:816 ESTELLE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2135
Mailing Address - Country:US
Mailing Address - Phone:717-898-8878
Mailing Address - Fax:717-898-4679
Practice Address - Street 1:816 ESTELLE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2135
Practice Address - Country:US
Practice Address - Phone:717-898-8878
Practice Address - Fax:717-898-4679
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEGOOO731152W00000X, 152WP0200X
PA0EG000731152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT84880Medicare UPIN
PA555331JHTMedicare PIN