Provider Demographics
NPI:1700062114
Name:O'DONNELL, PATRICK J (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 STATE ROUTE 118
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-5022
Mailing Address - Country:US
Mailing Address - Phone:570-477-1208
Mailing Address - Fax:570-477-1208
Practice Address - Street 1:2447 STATE ROUTE 118
Practice Address - Street 2:
Practice Address - City:HUNLOCK CREEK
Practice Address - State:PA
Practice Address - Zip Code:18621-5022
Practice Address - Country:US
Practice Address - Phone:570-477-1208
Practice Address - Fax:570-477-1208
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician