Healthcare Provider Details

I. General information

NPI: 1558374074
Provider Name (Legal Business Name): KAREN MARIE WRIGLEY-HAAK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN M, WRIGLEY O.D.

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 CHESTNUT ST SUITE 105
PHILADELPHIA PA
19103-3401
US

IV. Provider business mailing address

1919 CHESTNUT ST SUITE 105
PHILADELPHIA PA
19103-3401
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-8440
  • Fax: 215-567-4993
Mailing address:
  • Phone: 215-563-8440
  • Fax: 215-567-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000841
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000841
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: