Healthcare Provider Details

I. General information

NPI: 1619948627
Provider Name (Legal Business Name): DONNA BIERNACKI MC LAUGHLIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S WASHINGTON ST
WILKES BARRE PA
18701-3029
US

IV. Provider business mailing address

155 RIDGE CREST DR
MOUNTAIN TOP PA
18707-1536
US

V. Phone/Fax

Practice location:
  • Phone: 570-823-0290
  • Fax: 570-823-8511
Mailing address:
  • Phone: 570-474-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: