Daniel Robert Petley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG-369 Issued in PA

Practice address

1701 S 5TH Ave
Lebanon, PA 17042-7908

Phone

(717) 228-6173

NPI assigned

Feb 14, 2006

Last updated

Aug 6, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186358400000",
    "number": "1093789505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 S 5TH AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427908",
            "telephone_number": "717-228-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 S 5TH AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427908",
            "telephone_number": "717-228-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETLEY",
        "first_name": "DANIEL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2007-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG-369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amijo Perrine
• Elizabeth A Petcov, CRNP
• Nicole Renee Peter
• Levi Peters, NP
• Michelle Peterson
• Anthony Salvadore Petrole, PA-C
• Kathleen Goddard Petzold, PHARMD
• Cecelia S Pharris, LCSW
• Sereyvisale Pheng, PHARMD
• Seth Pheng

• Optometrist in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.