=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740463884
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN KIELAR OPTICIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2007
-----------------------------------------------------
Last Update Date | 12/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78 SALEM AVE
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18407-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-282-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 SALEM AVE
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18407-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-282-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------