Organization
MARY REED DACANAL, OD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY REED DACANAL OD (OPTOMETRIST/OWNER)
(814) 965-3231
Entity
Organization
Contact information
Practice address
516 MARKET ST, JOHNSONBURG, PA 15845-1240
(814) 965-3231
(814) 965-5483
Mailing address
516 MARKET ST, JOHNSONBURG, PA 15845-1240
(814) 965-3231
(814) 965-5483
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000721
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069767
MEDICARE ID-TYPE UNSPECIF
PA
05
—
1012058380001
—
PA
Enumeration date
07/19/2007
Last updated
02/20/2009
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