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General NPI Number Information
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NPI Number | 1083734420
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Entity Type | Organization
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Legal Business Name | FATULA FAMILY EYECARE
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1102 MILLION DOLLAR HWY
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City | SAINT MARYS
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State | PA
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Zip | 15857-2728
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Country | US
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Telephone | 814-781-1064
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Fax | 814-834-1243
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Provider Business Mailing Address
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Address Line | 111 EVERGREEN ST
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City | DU BOIS
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State | PA
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Zip | 15801-1722
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Country | US
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Telephone | 814-371-8210
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Fax | 814-834-1243
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DANIEL REMO FATULA
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Credential | O.D.
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Telephone | 814-371-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG001789
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License Number State | PA
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