MEDICARE: JANIDLO OPTOMETRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1255841565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANIDLO OPTOMETRY PC

Provider Business Mailing Address
First Line	:	120 W PENN ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1223
Country	:	US
Telephone Number	:	814-623-5018
Fax Number	:	814-623-7718

Provider Business Practice Location Address
First Line	:	120 W PENN ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1223
Country	:	US
Telephone Number	:	814-623-5018
Fax Number	:	814-623-7718

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. HEATHER KERR JANIDLO
Credential	:	OD
Telephone Number	:	814-423-2030

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	09/21/2018

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Directions to “JANIDLO OPTOMETRY PC ” Practice Location

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