Healthcare Provider Details

I. General information

NPI: 1417874868
Provider Name (Legal Business Name): MADELYN SINGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 WINDMERE DR STE 100
STATE COLLEGE PA
16801-7644
US

IV. Provider business mailing address

428 WINDMERE DR STE 100
STATE COLLEGE PA
16801-7644
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-2015
  • Fax:
Mailing address:
  • Phone: 814-234-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004386
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: