Provider Demographics
NPI:1790757094
Name:ANOIA, GREGORY ALBERT SR (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALBERT
Last Name:ANOIA
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W WATER ST
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-1231
Mailing Address - Country:US
Mailing Address - Phone:717-944-3201
Mailing Address - Fax:
Practice Address - Street 1:120 WEST WATER STREET
Practice Address - Street 2:BOX 160
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057
Practice Address - Country:US
Practice Address - Phone:717-944-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U01452Medicare UPIN
PA4033500001Medicare NSC