Healthcare Provider Details

I. General information

NPI: 1215844717
Provider Name (Legal Business Name): ADANNA URSULA OBIDIEGWU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 ESTELLE DR
LANCASTER PA
17601-2135
US

IV. Provider business mailing address

816 ESTELLE DR
LANCASTER PA
17601-2135
US

V. Phone/Fax

Practice location:
  • Phone: 717-898-8878
  • Fax:
Mailing address:
  • Phone: 717-898-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004418
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: