=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487823548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARL W WOLFE,OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2008
-----------------------------------------------------
Last Update Date | 02/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 968 S SAINT MARYS ST
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15857-2833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-781-3384
-----------------------------------------------------
Fax | 814-781-3389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 968 S SAINT MARYS ST
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15857-2833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-781-3384
-----------------------------------------------------
Fax | 814-781-3389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KARL WRAY WOLFE
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 817-781-3384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG000624
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------