Healthcare Provider Details

I. General information

NPI: 1942205745
Provider Name (Legal Business Name): DANA MIGNOGNA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 GRAPE ST
WHITEHALL PA
18052-5207
US

IV. Provider business mailing address

706 GRAPE ST
WHITEHALL PA
18052-5207
US

V. Phone/Fax

Practice location:
  • Phone: 610-266-7700
  • Fax: 610-266-9300
Mailing address:
  • Phone: 610-266-7700
  • Fax: 610-266-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE007800T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: