Provider Demographics
NPI:1154359057
Name:FERRARI, JOHN R (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:FERRARI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033
Mailing Address - Country:US
Mailing Address - Phone:610-534-1121
Mailing Address - Fax:610-534-1122
Practice Address - Street 1:145 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033
Practice Address - Country:US
Practice Address - Phone:610-534-1121
Practice Address - Fax:610-534-1122
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0632034Medicaid
PA0632034Medicaid
FE284239Medicare ID - Type Unspecified