Healthcare Provider Details

I. General information

NPI: 1720091242
Provider Name (Legal Business Name): KAREN M. WRIGLEY, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

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

VIII. Authorized Official

Name: DR. KAREN M WRIGLEY
Title or Position: OWNER
Credential: O.D.
Phone: 215-563-8440