Healthcare Provider Details

I. General information

NPI: 1124211230
Provider Name (Legal Business Name): JOHN R AUBREY OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 FRANKLIN ST
JOHNSTOWN PA
15901-2824
US

IV. Provider business mailing address

722 FRANKLIN ST
JOHNSTOWN PA
15901-2824
US

V. Phone/Fax

Practice location:
  • Phone: 814-535-8697
  • Fax: 814-535-8698
Mailing address:
  • Phone: 814-535-8697
  • Fax: 814-535-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001204
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOEG001204
License Number StatePA

VIII. Authorized Official

Name: DR. JOHN R AUBREY
Title or Position: OPTOMETRIST
Credential: OD
Phone: 814-535-8697