Provider Demographics
NPI:1679568166
Name:MARINCHAK, CHERYL L (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:MARINCHAK
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 1:158 MALL RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-8754
Mailing Address - Country:US
Mailing Address - Phone:610-377-8585
Mailing Address - Fax:610-377-8586
Practice Address - Street 1:158 MALL RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-8754
Practice Address - Country:US
Practice Address - Phone:610-377-8585
Practice Address - Fax:610-377-8586
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006202T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30495Medicare UPIN
PA448482Medicare ID - Type Unspecified