Healthcare Provider Details

I. General information

NPI: 1437193034
Provider Name (Legal Business Name): JAMES P. MCAVOY, O.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N CHURCH ST SUITE 100
HAZLETON PA
18202-1453
US

IV. Provider business mailing address

1201 N CHURCH ST SUITE 100
HAZLETON PA
18202-1453
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-6302
  • Fax: 570-454-3564
Mailing address:
  • Phone: 570-454-6302
  • Fax: 570-454-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001270
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0015963170001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MS. TAMI A. BINDAS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 570-454-6302