Provider Demographics
NPI:1669497889
Name:STOLTZFUS, MERVIN W
Entity type:Individual
Prefix:DR
First Name:MERVIN
Middle Name:W
Last Name:STOLTZFUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:PA
Mailing Address - Zip Code:17509-0075
Mailing Address - Country:US
Mailing Address - Phone:610-593-6670
Mailing Address - Fax:
Practice Address - Street 1:316 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509-1312
Practice Address - Country:US
Practice Address - Phone:610-593-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0546535Medicaid
033610Medicare ID - Type Unspecified
0518120001Medicare NSC
T27207Medicare UPIN