Provider Demographics
NPI:1093827164
Name:JD PEARAH MD LTD
Entity Type:Organization
Organization Name:JD PEARAH MD LTD
Other - Org Name:PENN AVENUE OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-678-4552
Mailing Address - Street 1:3855 PENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1174
Mailing Address - Country:US
Mailing Address - Phone:610-678-4716
Mailing Address - Fax:610-678-7007
Practice Address - Street 1:3855 PENN AVENUE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1174
Practice Address - Country:US
Practice Address - Phone:610-678-4716
Practice Address - Fax:610-678-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0315410001Medicare NSC