Healthcare Provider Details
I. General information
NPI: 1376643999
Provider Name (Legal Business Name): KARL E. STREILEIN O.D., PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 09/24/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
216 N CENTER ST
CORRY PA
16407-1627
US
IV. Provider business mailing address
216 N CENTER ST
CORRY PA
16407-1627
US
V. Phone/Fax
- Phone: 814-665-2020
- Fax: 814-664-4382
- Phone: 814-665-2020
- Fax: 814-664-4382
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | OEG001563 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | PA6532 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | EYEMED |
| # 2 | |
| Identifier | 0011539530005 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 3 | |
| Identifier | 1901014-0139 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | NATIONAL VISION ADMIN |
| # 4 | |
| Identifier | KA715401 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | BLUE SHIELD |
| # 5 | |
| Identifier | 42287 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | DAVIS VISION |
| # 6 | |
| Identifier | 9-6532 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | VISION BENEFITS OF AMERIC |
| # 7 | |
| Identifier | KA1347367 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | BLUE SHIELD |
| # 8 | |
| Identifier | 6532 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | VISION BENEFITS OF AMERIC |
| # 9 | |
| Identifier | 0011539530006 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 10 | |
| Identifier | 1901014-0239 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | NATIONAL VISION ADMIN |
| # 11 | |
| Identifier | 42289 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | DAVIS VISION |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
