Provider Demographics
NPI:1598739567
Name:BULIANO SMITH, MEGAN (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BULIANO SMITH
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 1:30 MEDICAL CENTER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3955
Mailing Address - Country:US
Mailing Address - Phone:610-874-5261
Mailing Address - Fax:610-874-0318
Practice Address - Street 1:30 MEDICAL CENTER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-874-5261
Practice Address - Fax:610-874-0318
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011889240001Medicaid
PAU93878Medicare UPIN