Provider Demographics
NPI:1700236825
Name:BELANGER, CORINNE ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:ELIZABETH
Last Name:BELANGER
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 1:2942 ROUTE 611 STE 105
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-7924
Mailing Address - Country:US
Mailing Address - Phone:570-421-3342
Mailing Address - Fax:570-421-8940
Practice Address - Street 1:2942 ROUTE 611 STE 105
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372
Practice Address - Country:US
Practice Address - Phone:570-421-3342
Practice Address - Fax:570-421-8490
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003166152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics