Healthcare Provider Details

I. General information

NPI: 1114180783
Provider Name (Legal Business Name): MEGAN WALSH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN WESNAK OD

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIFFLIN AVE
SCRANTON PA
18503-1982
US

IV. Provider business mailing address

1402 WASHBURN ST
SCRANTON PA
18504-2429
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3145
  • Fax: 570-343-3286
Mailing address:
  • Phone: 570-343-2591
  • Fax: 570-343-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002091
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102794393001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: