Healthcare Provider Details

I. General information

NPI: 1275625352
Provider Name (Legal Business Name): JOHN JOSEPH PIRRO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 CHEWS LANDING RD KERRY LYNN OPTICIANS
LAUREL SPRINGS NJ
08021-2804
US

IV. Provider business mailing address

1230 CHEWS LANDING RD KERRY LYNN OPTICIANS
LAUREL SPRINGS NJ
08021-2804
US

V. Phone/Fax

Practice location:
  • Phone: 856-784-4141
  • Fax: 856-784-0068
Mailing address:
  • Phone: 856-784-4141
  • Fax: 856-784-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00458100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: