MEDICARE: LONNY C WARE 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	OEG000708	PA

General Provider Information

NPI Number	:	1740250455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNY C WARE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:
City	:	SANDY LAKE
State	:	PA
Zip	:	16145
Country	:	US
Telephone Number	:	724-376-3881
Fax Number	:	724-376-3882

Provider Business Practice Location Address
First Line	:	33 WALNUT ST
Second Line	:
City	:	SANDY LAKE
State	:	PA
Zip	:	16145
Country	:	US
Telephone Number	:	724-376-3881
Fax Number	:	724-376-3882

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	01/07/2008

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