Provider Demographics
NPI:1548828395
Name:CORLE, ALEX J (OD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:J
Last Name:CORLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1257
Mailing Address - Country:US
Mailing Address - Phone:146-526-2218
Mailing Address - Fax:814-652-6413
Practice Address - Street 1:33 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1257
Practice Address - Country:US
Practice Address - Phone:814-652-6221
Practice Address - Fax:814-652-9143
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG003584OtherPA-LICENSE