John Joseph Shedlock, O.D. – Optometrist

Key facts

NPI: 1184889388
Entity type: Individual (NPI type 1)
Primary specialty: Optometrist 152W00000X
License: OEG002084 (PA)
Practice address: 612 Clara St Ste 1
Houtzdale, PA 16651-1115
Phone: (814) 378-7700
Fax: (814) 378-7704
NPI assigned: Jul 28, 2008
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Moshannon Valley Eye Care LLC Optometrist · Houtzdale, PA · NPI 1205107356

Medicare reassignment Care Compare group NPD Authorized official OPTOMETRIST · PA

Medicare Care Compare profile

Specialty: Optometry
Education: Pennsylvania College of Optometry, 2008
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Moshannon Valley Eye Care LLC (2 clinicians)

Practice addresses (Care Compare)

612 Clara St
Suite 1
Houtzdale, PA 16651-1115
Phone (814) 378-7700

Procedures performed for Medicare patients

Procedure	Number of procedures
Cataract surgery	13

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20081014000770	PA	Practitioner - Optometry	2567520851	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Moshannon Valley Eye Care LLC	Optometrist	Current since Jul 1, 2012	Accepting new patients

Locations

612 Clara St
#1
Houtzdale, PA 16651
Phone (814) 378-7700

612 Clara St
Houtzdale, PA 16651
Phone (814) 378-9716

315 Colonnade Blvd
State College, PA 16803
Phone (814) 861-8657

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	OEG002084	PA	Yes

Addresses

Primary practice location

612 Clara St Ste 1
Houtzdale, PA 16651-1115

Mailing address

612 Clara St Suite 1
Houtzdale, PA 16651-9510
Phone (814) 378-7700

Other identifiers

Identifier	Type	State	Issuer
102260899 0001	Medicaid	PA

Other providers in Houtzdale, PA

Moshannon Valley School District
Jennifer Marie Neely-Aurandt, M.S. OTR/L
Pierre Boumerhi DMD LLC
Tess Randolph
Anthony F Shedlock, DO
Robin L Tate, OT
Tyrone Hospital
Irving Witonsky, DMD
Lisa A Woods, LCSW
Michael L Zalno, ATC

All providers in Houtzdale, PA · Optometrist in Pennsylvania

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.