MEDICARE: DR. LAURIE COSTARELLI OD

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	OEG000097	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01491501	OTHER	PA	CAPITAL BLUE CROSS
2	067283	OTHER	PA	KEYSTONE HEALTH PLAN CENT
3	C0067283	OTHER	PA	BLUE SHIELD
4	816234	OTHER	PA	FIRST PRIORITY HEALTH

General Provider Information

NPI Number	:	1417955600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE COSTARELLI OD

Provider Business Mailing Address
First Line	:	301 EAST ST
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1846
Country	:	US
Telephone Number	:	570-387-8800
Fax Number	:	570-784-8887

Provider Business Practice Location Address
First Line	:	301 EAST ST
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1846
Country	:	US
Telephone Number	:	570-387-8800
Fax Number	:	570-784-8887

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

Similar Medicare Providers

1174521371 — NICHOLAS DROBNY OD
Practice Location Address:

301 EAST ST
BLOOMSBURG, PA
17815-1846

Practice Phone: 570-387-8800
Practice Fax: 570-784-8887

1255339065 — BLOOM VISION, LLC
Practice Location Address:

301 EAST ST
BLOOMSBURG, PA
17815-1846

Practice Phone: 570-387-8800
Practice Fax: 570-784-8887

1417705625 — BOGAR VISION CARE LLC
Practice Location Address:

301 EAST ST
BLOOMSBURG, PA
17815-1846

Practice Phone: 570-387-8800
Practice Fax:

1437647468 — NISAR KHAN MD
Practice Location Address:

425 E 1ST ST
BLOOMSBURG, PA
17815-1480

Practice Phone: 570-387-2055
Practice Fax: 570-387-2056

1306728183 — NICOLE MIDDLETON PHARMD
Practice Location Address:

823 NEW BERWICK HWY
BLOOMSBURG, PA
17815-2325

Practice Phone: 570-784-8061
Practice Fax:

1063344901 — CYNTHIA TEMPLIN LSW
Practice Location Address:

273 E 7TH ST
BLOOMSBURG, PA
17815-2853

Practice Phone: 570-847-4623
Practice Fax:

Directions to “ DR. LAURIE COSTARELLI OD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.