Judge, Mary Ellen
Judge, Mary Ellen is an individual health care provider with primary practice located at 679 Kidder St , Wilkes Barre PA 18702-6908. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Judge, Mary Ellen can be contacted via phone (570) 825-3491.Contact Information
Primary practice address
679 Kidder St
Wilkes Barre PA 18702-6908
Phone: (570) 825-3491
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OE006896T | Pennsylvania |
Profile Details
| NPI number | 1124012471 |
|---|---|
| LBN Legal business name | Judge, Mary Ellen |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 1st, 2005 |
| Last updated | Dec 1st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124012471 | NPPES |
| Pennsylvania | MEDICAID | 0070462900002 |
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