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General NPI Number Information
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NPI Number | 1275719429
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Entity Type | Organization
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Legal Business Name | JOHN OPALKA OD & ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 131 N MCKEAN ST
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City | KITTANNING
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State | PA
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Zip | 16201-1565
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Country | US
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Telephone | 724-543-2702
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Fax | 724-543-5171
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Provider Business Mailing Address
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Address Line | 131 N MCKEAN ST
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City | KITTANNING
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State | PA
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Zip | 16201-1565
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Country | US
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Telephone | 724-543-2702
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Fax | 724-543-5171
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. JOHN OPALKA
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Credential | O.D.
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Telephone | 724-543-2702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000706
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License Number State | PA
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