Provider Demographics
NPI:1730272030
Name:SULAK, DAVID WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:SULAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 LINCOLN HWY
Mailing Address - Street 2:P.O.BOX 599
Mailing Address - City:SADSBURYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19369
Mailing Address - Country:US
Mailing Address - Phone:610-857-2291
Mailing Address - Fax:610-857-2297
Practice Address - Street 1:2979 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:SADSBURYVILLE
Practice Address - State:PA
Practice Address - Zip Code:19369
Practice Address - Country:US
Practice Address - Phone:610-857-2291
Practice Address - Fax:610-857-2297
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018808050004Medicaid
U90247Medicare UPIN
PA0018808050004Medicaid