Healthcare Provider Details

I. General information

NPI: 1366628950
Provider Name (Legal Business Name): JAMES T. RHOADES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WATER ST
MASONTOWN PA
15461-1778
US

IV. Provider business mailing address

500 N WATER ST
MASONTOWN PA
15461-1778
US

V. Phone/Fax

Practice location:
  • Phone: 724-583-8338
  • Fax: 724-583-7037
Mailing address:
  • Phone: 724-583-8338
  • Fax: 724-583-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05416
License Number StatePA

VIII. Authorized Official

Name: JAMES T. RHOADES
Title or Position: OPTOMETRIST
Credential:
Phone: 724-583-8338