MEDICARE: RICHARD L JAHNLE MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		PA
2	207W00000X	Ophthalmology Physician		PA

General Provider Information

NPI Number	:	1689949067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L JAHNLE MD PC

Provider Business Mailing Address
First Line	:	2010 W CHESTER PIKE
Second Line	:	WELLNESS CENTER; SUITE 310
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2737
Country	:	US
Telephone Number	:	610-446-2260
Fax Number	:	610-446-3360

Provider Business Practice Location Address
First Line	:	2010 W CHESTER PIKE
Second Line	:	WELLNESS CENTER; SUITE 310
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2737
Country	:	US
Telephone Number	:	610-446-2260
Fax Number	:	610-446-3360

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD L. JAHNLE
Credential	:	MD
Telephone Number	:	610-446-2260

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	05/07/2012

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