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Individual

PETER E DODGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
4371 UNION DEPOSIT RD, HARRISBURG, PA 17111-2905
(717) 561-1660
(717) 561-8314
Mailing address
4371 UNION DEPOSIT RD, HARRISBURG, PA 17111-2905
(717) 561-1660
(717) 561-8314

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000403
PA
152WC0802X
Corneal and Contact Management Optometrist
OEG000403
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
096486
HIGHMARK BLUE SHIELD
PA
01
50003812
CAPITAL BLUE CROSS
PA
Enumeration date
05/06/2006
Last updated
05/07/2008
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