Provider Demographics
NPI:1740392448
Name:UMBEL, FORREST KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:KEITH
Last Name:UMBEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:F
Other - Middle Name:KEITH
Other - Last Name:UMBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:60 SUE ANNE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3652
Mailing Address - Country:US
Mailing Address - Phone:724-357-9929
Mailing Address - Fax:
Practice Address - Street 1:3100 OAKLAND AVE
Practice Address - Street 2:C/O WALMART VISION CENTER
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3240
Practice Address - Country:US
Practice Address - Phone:724-349-5671
Practice Address - Fax:724-340-6375
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001740107001Medicaid
PA30460Medicare UPIN
PA442679Medicare ID - Type Unspecified