MEDICARE: FATULA FAMILY EYECARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001789	PA

General Provider Information

NPI Number	:	1083734420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATULA FAMILY EYECARE

Provider Business Mailing Address
First Line	:	111 EVERGREEN ST
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-1722
Country	:	US
Telephone Number	:	814-371-8210
Fax Number	:	814-834-1243

Provider Business Practice Location Address
First Line	:	1102 MILLION DOLLAR HWY
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-2728
Country	:	US
Telephone Number	:	814-781-1064
Fax Number	:	814-834-1243

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DANIEL REMO FATULA
Credential	:	O.D.
Telephone Number	:	814-371-8210

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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