Provider Demographics
NPI:1699744649
Name:VERMA, RITA (OD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:VERMA
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 1:3 HOSPITAL DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9394
Mailing Address - Country:US
Mailing Address - Phone:570-524-4473
Mailing Address - Fax:570-524-4464
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9394
Practice Address - Country:US
Practice Address - Phone:570-524-4473
Practice Address - Fax:570-524-4464
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA457256Medicare ID - Type Unspecified
U08289Medicare UPIN