Provider Demographics
NPI:1821094137
Name:HORNBERGER, DAWN E (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:E
Last Name:HORNBERGER
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 1:247 E PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1613
Mailing Address - Country:US
Mailing Address - Phone:610-678-7202
Mailing Address - Fax:610-678-9866
Practice Address - Street 1:247 E PENN AVE
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-1613
Practice Address - Country:US
Practice Address - Phone:610-678-7202
Practice Address - Fax:610-678-9866
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000172152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
1412523OtherUHC
PA13271OtherAETNA HMO
PA4357090OtherAETNA PPO
PAHO564182OtherHIGHMARK BLUE SHIELD
P00418995OtherRAILROAD MEDICARE
28523OtherGEISINGER
PA410032260OtherRAILROAD MEDICARE
PA0651448-03OtherCIGNA
PA50003673OtherCAPITAL BLUE CROSS
PAT87948Medicare UPIN
PA564182Medicare ID - Type Unspecified