Provider Demographics
NPI:1366525347
Name:GREGORY, JOHN KARL (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KARL
Last Name:GREGORY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2275 SWALLOW HILL RD
Mailing Address - Street 2:BUILDING 700
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1656
Mailing Address - Country:US
Mailing Address - Phone:412-489-6726
Mailing Address - Fax:412-489-6732
Practice Address - Street 1:2275 SWALLOW HILL RD
Practice Address - Street 2:BUILDING 700
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1656
Practice Address - Country:US
Practice Address - Phone:412-489-6726
Practice Address - Fax:412-489-6732
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA424617Medicare ID - Type Unspecified
PAU50936Medicare UPIN