Provider Demographics
NPI:1144226655
Name:EDER, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:EDER
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 1:2627 WEST CUMBERLAND STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-272-3068
Mailing Address - Fax:
Practice Address - Street 1:2627 WEST CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004514752OtherAETNA
PA000038353OtherFEDERAL EMPLOYEE PROGRAM
PA000038353OtherHIGHMARK BLUE SHIELD
PA038353OtherHEALTHNOW (DMERC)
PAU06674OtherHEALTH AMERICA/ADVANTRA
PAU06674OtherHEALTHASSURANCE
PA2000153OtherKEYSTONE HEALTH PLAN
PA38081OtherGEISINGER
PA410040479OtherPALMETTO
PA000038353OtherCLARITY VISION
PA01433601OtherCAPTIAL BLUE CROSS
PA01433601OtherNCAS
PAU06674OtherHEALTHGUARD
PA000038353OtherFEDERAL EMPLOYEE PROGRAM
PAU06674OtherHEALTHASSURANCE
PA01433601OtherCAPTIAL BLUE CROSS