MEDICARE: DR. ANTONI MICHAEL WICHRYK O.D.

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	OEG000242	PA

General Provider Information

NPI Number	:	1174611925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONI MICHAEL WICHRYK O.D.

Provider Business Mailing Address
First Line	:	6451 VILLAGE LN
Second Line	:	SUITE 200
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-965-1800
Fax Number	:	610-965-1805

Provider Business Practice Location Address
First Line	:	6451 VILLAGE LN
Second Line	:	SUITE 200
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-965-1800
Fax Number	:	610-965-1805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	12/11/2014

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