Provider Demographics
NPI:1033297221
Name:PAULSON, JAMES BURTON (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BURTON
Last Name:PAULSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-6011
Mailing Address - Country:US
Mailing Address - Phone:814-734-6161
Mailing Address - Fax:814-734-6363
Practice Address - Street 1:135 ERIE ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-6011
Practice Address - Country:US
Practice Address - Phone:814-734-6161
Practice Address - Fax:814-734-6363
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOB008664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49657Medicare UPIN
770029Medicare ID - Type Unspecified