Healthcare Provider Details

I. General information

NPI: 1720020019
Provider Name (Legal Business Name): MERVIN W STOLTZFUS OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 NEWPORT AVE
CHRISTIANA PA
17509-1312
US

IV. Provider business mailing address

PO BOX 75
CHRISTIANA PA
17509
US

V. Phone/Fax

Practice location:
  • Phone: 610-593-6670
  • Fax:
Mailing address:
  • Phone: 610-593-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001396
License Number StatePA

VIII. Authorized Official

Name: DR. MERVIN W STOLTZFUS
Title or Position: OWNER
Credential:
Phone: 610-593-6670