Individual
DR. JAMES M TICKNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D., M.A.
Contact information
Practice address
777 OLD WILLOW AVE, HONESDALE, PA 18431-4217
(570) 251-9657
Mailing address
PO BOX 391, LAKE ARIEL, PA 18436-0391
(570) 251-9657
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001159
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1510066
HIGHMARK BLUESHIELD PIN
PA
01
—
817310
FIRST PRIORITY PIN
PA
01
—
82187
GEISINGER PIN NUMBER
PA
Enumeration date
05/01/2006
Last updated
07/09/2007
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