Provider Demographics
NPI:1235129941
Name:OPALKA, JOHN D (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:OPALKA
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 1:131 N MCKEAN ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-1565
Mailing Address - Country:US
Mailing Address - Phone:724-543-2702
Mailing Address - Fax:724-543-5171
Practice Address - Street 1:131 N MCKEAN ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-1565
Practice Address - Country:US
Practice Address - Phone:724-543-2702
Practice Address - Fax:724-543-5171
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01720857Medicaid
PA01720857Medicaid
PAOP562686Medicare ID - Type Unspecified