Individual
DR. LAURIE COSTARELLI
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
301 EAST ST, BLOOMSBURG, PA 17815-1846
(570) 387-8800
(570) 784-8887
Mailing address
301 EAST ST, BLOOMSBURG, PA 17815-1846
(570) 387-8800
(570) 784-8887
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000097
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01491501
CAPITAL BLUE CROSS
PA
01
—
067283
KEYSTONE HEALTH PLAN CENT
PA
01
—
816234
FIRST PRIORITY HEALTH
PA
01
—
C0067283
BLUE SHIELD
PA
Enumeration date
07/12/2005
Last updated
07/08/2007
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