Provider Demographics
NPI:1093730459
Name:CALLA, PETER JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:CALLA
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 1:2031 BELMONT AVE
Mailing Address - Street 2:V.A. OUTPATIENT CLINIC
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2401
Mailing Address - Country:US
Mailing Address - Phone:330-740-9200
Mailing Address - Fax:330-740-9240
Practice Address - Street 1:2031 BELMONT AVE
Practice Address - Street 2:V.A. OUTPATIENT CLINIC
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2401
Practice Address - Country:US
Practice Address - Phone:330-740-9200
Practice Address - Fax:330-740-9240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU92657Medicare UPIN