Provider Demographics
NPI:1235190638
Name:PELIZZARI, JOHN J (O D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:PELIZZARI
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 OLD US HIGHWAY 322
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-8953
Mailing Address - Country:US
Mailing Address - Phone:717-667-6023
Mailing Address - Fax:717-667-9597
Practice Address - Street 1:4704 OLD US HIGHWAY 322
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-8953
Practice Address - Country:US
Practice Address - Phone:717-667-6023
Practice Address - Fax:717-667-9597
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000951OtherSTATE LICENSE #
PA209259Medicare UPIN