Provider Demographics
NPI:1942205745
Name:MIGNOGNA, DANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:MIGNOGNA
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 1:706 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5207
Mailing Address - Country:US
Mailing Address - Phone:610-266-7700
Mailing Address - Fax:610-266-9300
Practice Address - Street 1:706 GRAPE ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5207
Practice Address - Country:US
Practice Address - Phone:610-266-7700
Practice Address - Fax:610-266-9300
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007800T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018424750001Medicaid
PA793976Medicare ID - Type UnspecifiedINDIV PA MEDICARE NUMBER
PA0018424750001Medicaid