John A Dudash, OD
Individual provider Active NPI Optometrist · New Eagle, PA
NPI 1619065729 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619065729
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 0E004668P (PA)
- Practice address
- 120 Main Street
New Eagle, PA 15067 - Phone
- (724) 258-3773
- Fax
- (724) 258-4805
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0E004668P | PA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Judith a Wentzel | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0E004668P | PA | Yes |
Addresses
Primary practice location
120 Main Street
New Eagle, PA 15067
Mailing address
120 Main Street PO Box 430
New Eagle, PA 15067
Phone (724) 258-3773
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01746334 | Medicaid | PA |
Other providers in New Eagle, PA
All providers in New Eagle, 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 Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.