Provider Demographics
NPI:1427115799
Name:OCULOPLASTIC CONSULTANTS OF CENTRAL PA
Entity type:Organization
Organization Name:OCULOPLASTIC CONSULTANTS OF CENTRAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHIETROMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-541-9700
Mailing Address - Street 1:4700 UNION DEPOSIT RD
Mailing Address - Street 2:#230
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111
Mailing Address - Country:US
Mailing Address - Phone:717-541-9700
Mailing Address - Fax:717-541-9705
Practice Address - Street 1:4700 UNION DEPOSIT RD
Practice Address - Street 2:#230
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111
Practice Address - Country:US
Practice Address - Phone:717-541-9700
Practice Address - Fax:717-541-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA6441OtherMEDICARE RAILROAD