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General NPI Number Information
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NPI Number | 1194999763
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Entity Type | Organization
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Legal Business Name | BRIAN ODONNELL, OD PC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 226 CAREY AVE
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City | WILKES BARRE
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State | PA
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Zip | 18702-2113
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Country | US
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Telephone | 570-826-8918
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Fax | 570-826-0240
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Provider Business Mailing Address
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Address Line | 226 CAREY AVE
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City | WILKES BARRE
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State | PA
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Zip | 18702-2113
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Country | US
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Telephone | 570-826-8918
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Fax | 570-826-0240
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. BRIAN O'DONNELL
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Credential | OD
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Telephone | 570-826-8918
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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 | OEG000463
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License Number State | PA
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