Individual
MARY TERESE DACANAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000721
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012058380001
—
PA
Enumeration date
09/27/2005
Last updated
10/22/2012
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