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General NPI Number Information
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NPI Number | 1922268143
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Entity Type | Individual
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Provider Name | PETER COSTARELLI OD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 16 WOODBINE LN
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City | DANVILLE
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State | PA
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Zip | 17821-8029
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Country | US
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Telephone | 570-271-6531
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Fax | 570-271-7146
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Provider Business Mailing Address
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Address Line | 100 N ACADEMY AVE # 4903
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City | DANVILLE
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State | PA
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Zip | 17822-9800
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Country | US
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Telephone | 570-271-6144
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Fax | 702-716-5785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG002713
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License Number State | PA
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