Basic Information
Provider Information | |||||||||
NPI: | 1710943345 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STRONGWATER | ||||||||
FirstName: | HILDY | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | OD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 441 NORTHAMPTON ST | ||||||||
Address2: |   | ||||||||
City: | EASTEN | ||||||||
State: | PA | ||||||||
PostalCode: | 18042 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6102538132 | ||||||||
FaxNumber: | 6102522286 | ||||||||
Practice Location | |||||||||
Address1: | 2414 MACARTHUR RD | ||||||||
Address2: |   | ||||||||
City: | WHITEHALL | ||||||||
State: | PA | ||||||||
PostalCode: | 180523810 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104323937 | ||||||||
FaxNumber: | 6104320124 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/22/2006 | ||||||||
LastUpdateDate: | 05/25/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OE006824T | PA | Y |   | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | 02541400 | 01 | PA | CAPITAL BLUE CROSS GROUP | OTHER | 0011401130004 | 05 | PA |   | MEDICAID | 01554301 | 01 | PA | CAPITAL BLUE CROSS | OTHER |