Individual
DR. DOUGLAS J VILLELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
300 STATE ST, SUITE 202, ERIE, PA 16507-1427
(814) 454-6517
(814) 454-0604
Mailing address
300 STATE ST, SUITE 202, ERIE, PA 16507-1427
(814) 454-6517
(814) 454-0604
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001102
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0727940001
DMERC A
PA
01
—
DG8866
R.R. MEDICARE
PA
Enumeration date
07/11/2006
Last updated
05/13/2008
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