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General NPI Number Information
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NPI Number | 1699060335
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Entity Type | Organization
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Legal Business Name | MARY REED DACANAL OD INC.
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 20 N BROAD ST
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City | RIDGWAY
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State | PA
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Zip | 15853-8018
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Country | US
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Telephone | 814-772-0674
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Fax |
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Provider Business Mailing Address
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Address Line | 20 N BROAD ST
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City | RIDGWAY
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State | PA
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Zip | 15853-8018
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Country | US
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Telephone | 814-772-0674
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MARY DACANAL
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Credential | OWNER
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Telephone | 814-772-0674
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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 | OEG000721
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License Number State | PA
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