Healthcare Provider Details

I. General information

NPI: 1235190638
Provider Name (Legal Business Name): JOHN J PELIZZARI O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 OLD US HIGHWAY 322
REEDSVILLE PA
17084-8953
US

IV. Provider business mailing address

4704 OLD US HIGHWAY 322
REEDSVILLE PA
17084-8953
US

V. Phone/Fax

Practice location:
  • Phone: 717-667-6023
  • Fax: 717-667-9597
Mailing address:
  • Phone: 717-667-6023
  • Fax: 717-667-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000951
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: