Individual
KRYSTAL MINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ABOC
Contact information
Practice address
233 W WALNUT ST, SHAMOKIN, PA 17872-5365
(570) 809-3893
Mailing address
233 W WALNUT ST, SHAMOKIN, PA 17872-5365
(570) 809-3893
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
252252
PA
Other
Enumeration date
06/27/2023
Last updated
06/27/2023
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