1275808347 NPI number — DAVID J KAIRYS ODPC

Table of content: (NPI 1275808347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275808347 NPI number — DAVID J KAIRYS ODPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID J KAIRYS ODPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROFESSIONAL VISION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275808347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5522 SHAFFER RD UNIT 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DU BOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-371-2211
Provider Business Mailing Address Fax Number:
814-371-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5522 SHAFFER RD UNIT 127
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-371-2211
Provider Business Practice Location Address Fax Number:
814-371-5015
Provider Enumeration Date:
03/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KAIRYS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-371-2211

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000054 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26109 . This is a "OPTUMHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 52270 . This is a "DAVIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8143712211 . This is a "VSP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 911047 . This is a "EYEMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012992050003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05522 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com