Healthcare Provider Details

I. General information

NPI: 1053316687
Provider Name (Legal Business Name): NICOLE M FORNEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 WESTVIEW DR
WYOMISSING PA
19610-1130
US

IV. Provider business mailing address

2624 WESTVIEW DR
WYOMISSING PA
19610-1130
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-1981
  • Fax: 610-376-3153
Mailing address:
  • Phone: 610-376-1981
  • Fax: 610-376-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001274
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: