Healthcare Provider Details

I. General information

NPI: 1760474647
Provider Name (Legal Business Name): DR. NANCY L HERROLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 BOARD ROAD
MOUNT WOLF PA
17347-9559
US

IV. Provider business mailing address

5100 BOARD ROAD
MOUNT WOLF PA
17347-9559
US

V. Phone/Fax

Practice location:
  • Phone: 717-266-6602
  • Fax: 717-266-0843
Mailing address:
  • Phone: 717-266-6602
  • Fax: 717-266-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOEG002151
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: