Provider Demographics
NPI:1740463884
Name:KIELAR, MAUREEN (OPTICIAN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:KIELAR
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2004
Mailing Address - Country:US
Mailing Address - Phone:570-282-2000
Mailing Address - Fax:
Practice Address - Street 1:78 SALEM AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2004
Practice Address - Country:US
Practice Address - Phone:570-282-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKI211041OtherBLUE CROSS BLUE SHIELD