MEDICARE: DR. DANA MIGNOGNA 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	OE007800T	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942205745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA MIGNOGNA O.D.

Provider Business Mailing Address
First Line	:	706 GRAPE ST
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-5207
Country	:	US
Telephone Number	:	610-266-7700
Fax Number	:	610-266-9300

Provider Business Practice Location Address
First Line	:	706 GRAPE ST
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-5207
Country	:	US
Telephone Number	:	610-266-7700
Fax Number	:	610-266-9300

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/09/2007

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