Individual
JENNIFER M COSTALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
100 N WALNUT ST, MECHANICSBURG, PA 17055-3364
(717) 628-3693
Mailing address
178 WALDEN WAY, MECHANICSBURG, PA 17050-4105
(724) 992-1917
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG002338
PA
152W00000X
Optometrist
OPT002590
GA
Other
Enumeration date
07/06/2010
Last updated
09/20/2023
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