Healthcare Provider Details

I. General information

NPI: 1073509386
Provider Name (Legal Business Name): RICHARD J VAHALY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 WHITE ST
YORK PA
17404-4900
US

IV. Provider business mailing address

2155 WHITE ST
YORK PA
17404-4900
US

V. Phone/Fax

Practice location:
  • Phone: 717-848-4654
  • Fax: 717-747-0123
Mailing address:
  • Phone: 717-848-4654
  • Fax: 717-747-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000147
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: