Provider Demographics
NPI:1881692135
Name:WILAMOWSKI, JANET MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:MARIE
Last Name:WILAMOWSKI
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 1:10106 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1111
Mailing Address - Country:US
Mailing Address - Phone:610-783-0615
Mailing Address - Fax:610-783-5497
Practice Address - Street 1:10106 VALLEY FORGE CIR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1111
Practice Address - Country:US
Practice Address - Phone:610-783-0615
Practice Address - Fax:610-783-5497
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006186-T152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017163000OtherKEYSTONE HP EAST
PA3656421OtherAETNA HMO
PAWI436421Medicare ID - Type Unspecified
PAU20826Medicare UPIN