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General NPI Number Information
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NPI Number | 1558392639
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Entity Type | Organization
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Legal Business Name | GARUNGA INC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 65 COUNTRY CLUB SHOPPING CTR
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City | DALLAS
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State | PA
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Zip | 18612-1235
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Country | US
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Telephone | 570-675-8888
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Fax | 570-675-8375
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Provider Business Mailing Address
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Address Line | 65 COUNTRY CLUB SHOPPING CTR
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City | DALLAS
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State | PA
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Zip | 18612-1235
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Country | US
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Telephone | 570-675-8888
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Fax | 570-675-8375
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. SANDRA A GROMELSKI
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Credential |
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Telephone | 570-675-8888
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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 | OE0004159P
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License Number State | PA
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