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General NPI Number Information
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NPI Number | 1609951078
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Entity Type | Organization
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Legal Business Name | OPHTHALMOLOGICAL ASSOCIATES OF LANCASTER
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 558 N DUKE ST
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City | LANCASTER
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State | PA
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Zip | 17602
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Country | US
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Telephone | 717-397-8259
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Fax | 717-397-1786
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Provider Business Mailing Address
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Address Line | 558 N DUKE ST
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City | LANCASTER
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State | PA
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Zip | 17602
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Country | US
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Telephone | 717-397-8259
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Fax | 717-397-1786
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DIANE MARIE CORALLO
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Credential | MD
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Telephone | 717-397-8259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 042035E
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License Number State | PA
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