Organization
FATULA FAMILY EYE CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL R FATULA OD (OWNER/PROVIDER)
(814) 913-3006
Entity
Organization
Contact information
Practice address
20 INDUSTRIAL DR, DU BOIS, PA 15801-3842
(814) 913-3006
(814) 371-2713
Mailing address
220 SYLVAN HEIGHTS DR, DU BOIS, PA 15801-5868
(814) 913-3006
(814) 371-2713
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001789
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024126310002
—
PA
Enumeration date
05/08/2014
Last updated
05/08/2014
Update your record
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