Provider Demographics
NPI:1174545925
Name:KORENKIEWICZ, TRICIA LOUISE (OD)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LOUISE
Last Name:KORENKIEWICZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:TRICIA
Other - Middle Name:LOUISE
Other - Last Name:FUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:927 CRYSTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2930
Mailing Address - Country:US
Mailing Address - Phone:610-494-6944
Mailing Address - Fax:610-566-6815
Practice Address - Street 1:1067 W BALTIMORE PKE
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5121
Practice Address - Country:US
Practice Address - Phone:610-565-3416
Practice Address - Fax:610-566-6815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000434794OtherHIGHMARK BLUE SHIELD
PA0970463OtherAETNA
PAPA8087OtherEYEMED
PA397177OtherNATIONAL VISION ADMINISTR
PA0316692000OtherINDEPENDENCE BLUE CROSS
PA0970463OtherAETNA