Healthcare Provider Details

I. General information

NPI: 1326035882
Provider Name (Legal Business Name): JOHN PETER ROMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 ARCH ST
PHILADELPHIA PA
19107-3011
US

IV. Provider business mailing address

1030 ARCH ST
PHILADELPHIA PA
19107-3011
US

V. Phone/Fax

Practice location:
  • Phone: 215-238-1444
  • Fax:
Mailing address:
  • Phone: 215-238-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG001966
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: