Provider Demographics
NPI:1760474647
Name:HERROLD, NANCY L
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:HERROLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 BOARD ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9559
Mailing Address - Country:US
Mailing Address - Phone:717-266-6602
Mailing Address - Fax:717-266-0843
Practice Address - Street 1:5100 BOARD ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-9559
Practice Address - Country:US
Practice Address - Phone:717-266-6602
Practice Address - Fax:717-266-0843
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002151152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0279840001Medicare NSC