Provider Demographics
NPI:1720198328
Name:CHARNECKI-SINCAVAGE, SUSAN J (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:CHARNECKI-SINCAVAGE
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 1:133 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4701
Mailing Address - Country:US
Mailing Address - Phone:570-752-2500
Mailing Address - Fax:570-752-8842
Practice Address - Street 1:133 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4701
Practice Address - Country:US
Practice Address - Phone:570-752-2500
Practice Address - Fax:570-752-8842
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU64275Medicare UPIN
PACH505894Medicare ID - Type Unspecified