Provider Demographics
NPI:1720039993
Name:DARDICK, JANET (OD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:DARDICK
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 1:5 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHIREMANSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17011-6310
Mailing Address - Country:US
Mailing Address - Phone:717-761-6023
Mailing Address - Fax:717-730-0928
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SHIREMANSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17011-6310
Practice Address - Country:US
Practice Address - Phone:717-761-6023
Practice Address - Fax:717-730-0928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT84879Medicare UPIN