Provider Demographics
NPI:1669435582
Name:PENNWOOD OPHTHALMIC ASSOCIATES, PC
Entity type:Organization
Organization Name:PENNWOOD OPHTHALMIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPHTHALMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:CORMAN
Authorized Official - Last Name:ERLICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-623-1969
Mailing Address - Street 1:311 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7022
Mailing Address - Country:US
Mailing Address - Phone:814-623-1969
Mailing Address - Fax:814-623-5590
Practice Address - Street 1:311 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7022
Practice Address - Country:US
Practice Address - Phone:814-623-1969
Practice Address - Fax:814-623-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172307OtherBCBS GROUP
PA0012470110004Medicaid
PA0016242330004Medicaid
PA172508OtherBCBS GROUP DR SHUKE
PA0011646070005Medicaid
PACB2806OtherRAILROAD MCARE GROUP
PAB42713Medicare UPIN
PA172307OtherBCBS GROUP
PA0012470110004Medicaid
PA0991180001Medicare NSC
PW030127Medicare ID - Type UnspecifiedGROUP ID MEDICARE