Provider Demographics
NPI:1124211230
Name:JOHN R AUBREY OD PC
Entity type:Organization
Organization Name:JOHN R AUBREY OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUBREY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-535-8697
Mailing Address - Street 1:722 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2824
Mailing Address - Country:US
Mailing Address - Phone:814-535-8697
Mailing Address - Fax:814-535-8698
Practice Address - Street 1:722 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2824
Practice Address - Country:US
Practice Address - Phone:814-535-8697
Practice Address - Fax:814-535-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001204332B00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008490500003Medicaid
PAT-28137Medicare UPIN
PA0231980001Medicare NSC
PA060162Medicare PIN