Provider Demographics
NPI:1699711770
Name:SOKOL, MARIE E (OD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:SOKOL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 RUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4801
Mailing Address - Country:US
Mailing Address - Phone:570-288-7405
Mailing Address - Fax:570-288-7406
Practice Address - Street 1:425 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2001
Practice Address - Country:US
Practice Address - Phone:570-558-3937
Practice Address - Fax:570-558-1734
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016538730001Medicaid
PA1016538730001Medicaid
P29929Medicare UPIN
PA174849Medicare ID - Type Unspecified