MEDICARE: MARY L PETRUNYAK 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	OEG455	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PE959756	OTHER	PA	HIGHMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1535716	OTHER	PA	UMWA HEALTH & WELFAREFUND

General Provider Information

NPI Number	:	1780684472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L PETRUNYAK OD

Provider Business Mailing Address
First Line	:	1008 MAPLE AVE
Second Line	:
City	:	NORTHERN CAMBRIA
State	:	PA
Zip	:	15714-1353
Country	:	US
Telephone Number	:	814-948-8600
Fax Number	:	814-948-8790

Provider Business Practice Location Address
First Line	:	1008 MAPLE AVE
Second Line	:
City	:	NORTHERN CAMBRIA
State	:	PA
Zip	:	15714-1353
Country	:	US
Telephone Number	:	814-948-8600
Fax Number	:	814-948-8790

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/10/2008

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Directions to “ MARY L PETRUNYAK OD” Practice Location

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